Separating the random murmur component of the phonocardiogram from the underlying deterministic heart sounds Applied to Digital Subtraction Phonocardiography (DSP)

We show that a new analytical technique, which we call Digital Subtraction Phonocardiography (DSP), can beused to separate the random murmur component of the phonocardiogram from the underlying deterministic heartsounds.We digitally recorded the phonocardiogram from the anterior chest wall in 52 infants and adults using a high-speed USB interface and. Digital Subtraction Analysis of the signal was performed using a custom computer program called Murmurgram. In essence, this program subtracts the recorded sound from two adjacent cardiac cycles to produce a difference signal, herein called a "murmurgram". Other software used included Spectrogram (Version 16), GoldWave (Version 5.55) as well as custom MATLAB code. Our preliminary data is presented as a series of five cases. These cases show how advanced signal processing techniques can be used to separate heart sounds from murmurs. Note that these results are preliminary in that normal ranges for obtained test results have not yet been established. Cardiac murmurs can be separated from underlying deterministic heart sounds using DSP. DSP has the potential to become a reliable and economical new diagnostic approach to screening for structural heart disease. However, DSP must be further evaluated in a large series of patients with wellcharacterized pathology to determine its clinical potential.