Wiggers diagram

Teaching aid in cardiac physiology
A Wiggers diagram modified from [1]

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
    Ventricular systole
  • Cardiac diastole
    Cardiac diastole
  • ECG
  • The EKG complex. P=P wave, PR=PR interval, QRS=QRS complex, QT=QT interval, ST=ST segment, T=T wave
    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 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]
    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

References

  1. ^ a b c d 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–A13654.
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