Pulsed HIFU beams are being increasingly used in a number of therapeutic applications, including thermal therapy, drug and gene delivery, and hemostasis. This wide range of applications is based on a range of HIFU-tissue interactions from purely thermal to purely mechanical to produce the desired therapeutic effects.We have developed a real-time system for monitoring tissue displacements in response to pulsed HIFU beams at high PRFs. The imaging component of the system comprises an FPGA-based signal processing unit for real-time filtering of M-mode pulseecho data followed by real-time speckle tracking for tissue displacements before, during, and after exposure to pulsed HIFU. The latter can be used in evaluating temperature and/or viscoelastic response to the applied HIFU beam. The high acquisition rate of the M-mode system, together with the real-time displacement tracking are necessary for simultaneous estimation and separation of the thermal and viscoelastic tissue responses. In addition, the system provides a real-time link to MATLAB-based nonlinear spectral estimation routines for cavitation detection. The system has been tested in vitro bovine heart tissue and the results show that the displacement tracking captures the full dynamics of tissue displacements for the full range of HIFU exposures of interest.