I.J. Image, Graphics and Signal Processing, 2018, 7, 34-41 Published Online July 2018 in MECS (http://www.mecs-press.org/) DOI: 10.5815/ijigsp.2018.07.04 Graphic Representations and Frequency Parameters of Heart Sound Signals

Božo Tomas Faculty of Mechanical Engineering and Computing, University of Mostar, Matice hrvatske bb, 88000, Mostar, Bosnia and Herzegovina Email: [email protected]

Darko Zelenika Faculty of Information Studies, Ljubljanska cesta 31A, 8000, Novo mesto, Slovenia Email: [email protected]

Željko Rončević University Clinical Hospital Mostar, Clinic for Children’s Diseases, Cardiology Department, Bijeli brijeg bb, 88000, Mostar, Bosnia and Herzegovina Email: [email protected]

Received: 24 April 2018; Accepted: 16 May 2018; Published: 08 July 2018

Abstract—Sounds produced by acoustic activity of the (1781-1826) invented the stethoscope and introduced the heart are series (sequences) of quasi-periodic events term into medicine [1]. which are repeated throughout life, one period (cycle) of Heart auscultation is very subjective because diagnosis these events lasts less than one second. The of could be interpreted in several ways advancements in technology have enabled us to create depending on how a physician interprets the sound. Due various tools for audio and graphic representations of to limited opportunities of heart auscultation, it is these events. Physicians, by using such tools, can more necessary to help the human ear and make a graphic accurately determine diagnosis by interpretation of heart display of the heart sound. Visual representations of heart sound and/or by visual interpretation of graphic displays sound signals can help physicians to better understand, of heart sounds. This paper presents frequency determine and evaluate heart sound cycle events. parameters and graphic illustrations of heart sound Despite numerous heart sound graphic representations, signals for two groups of heart murmurs: innocent Still’s vast majority physicians do not really use them. One of murmur and pathologic of Ventricular the most common graphic representations of heart sound Septal Defect (VSD). Also, on behalf of the frequency signals is phonocardiogram (PCG) (the time display of analysis of acoustic cardiac signals with Still’s murmur heart sound amplitudes). Other display of heart sound was given a medical explanation of cause and origin of signals is the heart sound spectrogram which allows Still’s murmur. better heart sound interpretation, but it is hardly percepted or used by physicians. Index Terms—Heart Sound Frequency Parameters, Heart With this purpose, authors in [2] introduced a solution Sound Graphic Representation, Haert Sound Spectrogram, for graphic display of heart sounds called HSLs (Heart Phonocardiogram (PCG), Still’s Murmur, Ventricular Sound Lines). Authors believe that graphic display of Septal Defect (VSD). heart sound signals like this could be a useful tool for the heart sounds interpretation and can assist physicians for a more precise diagnosis of innocent and pathologic I. INTRODUCTION murmurs (auscultation-visual diagnosis). The advantage of HSLs graphical display over other methods is in its Our body transmits sound messages and easier interpretation by their parameters: murmurs color „speaks“ about the state of our vital organs (heart, line, numerical value of murmurs index and lines shape. lungs,..). Physicians listen and interpret these sounds. The paper is organised as follows. In Section II Auscultation is a medical term for listening of internal recordings of heart sound signals and Goertzel algorithm body sounds and the procedure of listening is mainly are shortly presented. In Section III are shown the done with a stetoscope. That term originates from the spectral compositions (spectral energy distributions) of Latin word auscultare, which means to listen. The Still’s and VSD’s murmur and their frequency parameters. beginning of auscultation started back in 1816 when Graphic representations of heart sounds are in Section IV. French physician René Théophile Hyacinthe Laennec Section V concludes the paper with final remarks.

Copyright © 2018 MECS I.J. Image, Graphics and Signal Processing, 2018, 7, 34-41 Graphic Representations and Frequency Parameters of Heart Sound Signals 35

frequency resolution and frequency band of analysed II. MATERIALS AND METHODS signal.

While examining the children in an outpatient clinic by pediatric cardiologists, their heart sounds were recorded III. SPECTRAL COMPOSITION AND FREQUENCY with an electronic stethoscope. All children were PARAMETERS OF HEART MURMURS additionally examined with ultrasound for an accurate diagnosis of congenital heart disease. The recorded heart The basic events of a heart sound cycle are first heart sounds were classified into three groups: heart sounds sound (S1), second heart sound (S2) and time periods without heart murmur – Normal (10 records), heart between them. A time between S1 and S2 is called a sounds with physiological Still´s innocent murmur – Still and a time period between S2 and S1 is called a (20 records) and heart sounds with pathological murmur diastole. If there is a sound (noise) which is heard through associated with congenital heart disease – VSD (20 the systole or diastole, that phenomenon is respectively records). called and . Heart sounds were recorded with the sampling When murmurs appear, they can last only a small part frequency of fs=8000 Hz and resolution of quantization of or entire systole i.e. diastole. The time interval of murmur 16 bits. Further more, in a process of determination of appearance is very short. At children age, a systolic time frequency parameters of the murmurs, the complete interval is around 200 ms and diastolic time interval is systolic duration was isolated (by hand using software little longer. tool Audacity) from the heart audio files. An energy Spectral composition of heart sound signals is very spectrum of the heart sound data was obtained by useful in detection and heart murmur diagnosis. Majority applying Goertzel algorithm. of authors in their studies mostly used FFT and/or Wavelet Transform for a spectral anlysis of the heart A. Basic Goertzel algorithm sounds [5-7]. Heart sound spectral analysis with Goertzel The algorithm was introduced by Gerald Goertzel algorithm is proposed in [8-9]. (1920-2002) in 1958 [3]. Equation (1) describes the In this analysis Goertzel algorithm was applied with signal flow for the basic Goertzel algorithm as each the sample block size of 160 samples. When using a sample is processed [4]. The signal flow of the algorithm sampling frequency of 8 kHz, 160 samples (N=160) in produces an output y0 for each processed sample. discrete time represent the time frame of 20 ms in real- 2휋푚 time. The bin bandwidth frequency is determined by 푦0 = 푥0 + 푦1 × 2푐표푠 ( ) − 푦2 (1) 푁 sampling frequency and sample block size (B=fs/N). The overlapping of bins (frequency resolution) is adjusted by In the equation (1), y0 denotes the current output, x0 denotes the current input sample, y denotes the output the selection of coefficient m in equations (1) and (2). 1 Figures 1 and 2 illustrate the results calculated by the that is previously processed, y2 denotes the second previously processed output, N denotes the size of input frequency resolution of 5 Hz. block, while m denotes bin number in the frequency Frequency parameters of heart murmurs carry domain. Each sample of the input block (of size N) is information about the health status of patient’s heart and processed accrding to the equation (1) and at the end of these parameters are determined and evaluated in hear