Wiggers diagram

A Wiggers diagram modified from

A Wiggers diagram, named after its developer, Carl Wiggers, is a unique diagram that has been used in teaching cardiac physiology for more than a century. ^{[1] [2]} In the Wiggers diagram, the X-axis is used to plot time subdivided into the cardiac phases, while the Y-axis typically contains the following on a single grid:

• Blood pressure
  • Aortic pressure
  • Ventricular pressure
  • Atrial pressure
• Ventricular volume
• Electrocardiogram
• Arterial flow (optional)
• Heart sounds (optional)

The Wiggers diagram clearly illustrates the coordinated variation of these values as the heart beats, assisting one in understanding the entire cardiac cycle. ^[1]

Events

	Phase	EKG	Heart sounds	Semilunar valves	Atrioventricular valves
A	Atrial systole	P	S4*	closed	open
B	Ventricular systole – Isovolumetric/isovolumic contraction	QRS	S1 ("lub")	closed	closed
C1	Ventricular systole – Ejection 1	ST		open	closed
C2	Ventricular systole – Ejection 2	T		open	closed
D	Ventricular diastole – Isovolumetric/isovolumic relaxation	–	S2 ("dub")	closed	closed
E1	Ventricular diastole – Ventricular filling 1	–	S3*	closed	open
E2	Ventricular diastole – Ventricular filling 2	–		closed	open

Note that during isovolumetric/isovolumic contraction and relaxation, all the heart valves are closed; at no time are all the heart valves open. ^[1] *S3 and S4 heart sounds are associated with pathologies and are not routinely heard.

Additional images

• 
  Ventricular systole
• 
  Cardiac diastole
• 
  ECG
• 
  The EKG complex. P=P wave, PR=PR interval, QRS=QRS complex, QT=QT interval, ST=ST segment, T=T wave
• 
  Wiggers with jugular venous waveform
• 
  Wiggers diagram with mechanical (echo), electrical (ECG), and aortic pressure (catheter) waveforms, together with an in-ear dynamic pressure waveform measured using a novel infrasonic hemodynography technology, for a patient with severe aortic stenosis. Modified from ^[3]

See also

• Pressure volume diagram

References

1. Mitchell, Jamie R.; Wang, Jiun Jr (2014-06-01). "Expanding application of the Wiggers diagram to teach cardiovascular physiology". Advances in Physiology Education. 38 (2): 170–175. doi:10.1152/advan.00123.2013. ISSN   1043-4046. PMC   4056172 . PMID   24913453.
2. Wiggers, Carl (1915). Circulation in Health and Disease. Philadelphia, PA: Lea & Febiger.
3. Waldman, Carly E; Patel, Siddarth (16 November 2021). "Abstract 13654: Can a Novel Earbud Technology Detect Severe Aortic Stenosis? Modernizing the Wiggers Diagram Through Infrasonic Hemodynography Synchronized With Echocardiography and Cardiac Catheterization". Circulation. 144 (Suppl_1). American Heart Association: A13654. doi:10.1161/circ.144.suppl_1.13654.