Extra Heart Sounds (s3 & s4)

This extra heart sounds category will help you learn about the auscultation of the third and fourth heart sounds including third heart sound gallop, fourth heart sound gallop, third and fourth heart sound gallop, and summation gallop at 120 beats per minutes.

The third heart sounds (S3) occur in the rapid filling period of early diastole. The fourth heart sound(S4) ensues in late diastolic periods right before the first heart sound.

Before you take this session you should have finished the normal heart sounds session, first heart sound, and second heart sound sessions. You should feel gratified with your ability to listen and be familiar with normal heart sounds.

Please use good quality headphones or earphones. Computer or phones speakers often fail to reproduce some heart sounds.

The third heart sound (S3), also described as the “ventricular gallop”. It betides just after the second heart sound when the mitral valve opens, allowing the acquiescent filling of the left ventricle. The third heart sound is produced by a large amount of blood cogent a very complaint left ventricle.

The fourth heart sound gallops manifest as a vibration of 20 to 30 Hz within the ventricle. If the complication lies with the left ventricle, the gallop rhythm will be heard best at the cardiac apex.

In medical practices, correct diagnosis and understanding of the case are important. So, while doing auscultation hearing the sounds correctly and identifying the abnormalities in them is important.

Having prior practice to the sound will be a plus point for you, as we can do better in things we are familiar with. So, this site will be a friend who will help you in gaining practice in auscultation and learning different cases regarding it. So, practice as much you want and gain your self-confidence, and learn for your future practices.

This site will always be a friend who will help you in case of learning about heart sounds.

Third Heart Sound Gallop

A low-frequency sound is heard with vibrations for a brief period at the early diastolic period. The term gallop was previously used to define three heart sounds occurring in succession. This is a bruit that completes the triple rhythm of the heart. This happens when the mitral valve opens and the heart starts to fill passively.

The auscultation of the third heart sound is very difficult, and it all depends on the practitioner’s auscultatory skills. This sound has a very low intensity which gets masked easily by external sounds and lung sounds.

This sound has a minimal radiation capacity and thus can be heard only in certain areas. For the auscultation of third heart sound, gallop raise the bed to make it comfortable for the examiner to auscultate. The third heart sound gallop is only heard if the patient is lying on its side.

Fourth Heart Sound Gallop

The fourth heart sound is also called the atrial gallop or presystolic heart sound. This occurs ahead of S1 when the contraction of atria forces the blood into the left ventricle. This is also a low-pitched voice arising shortly before the first heart sound.

This sound is occasionally present in healthy people, but mostly it is associated with the hypertrophy of ventricles, IHD, aortic stenosis, etc. It is a significant sign of diastolic heart failure.

This sound is also heard in older adults with less ventricular compliance. If you can palpate the fourth heart sounds gallop, there might be the risk of hypertension and cardiac pneumonia to the patient. Other causes of this gallop are delays in completion of the heart cycle.

Third and Fourth Heart Sound Gallop

The third and fourth heart sound gallop is heard when the heart is improving from the failure. The frequency of S4 is less than S3. The S3 configuration gives way to an S3 S4 configuration as the patient recovers.

To detect the third and fourth heart sound, gallop the bell of the stethoscope should be used. The practitioner should be skilled because this sound is only for a brief period. Ask the patient to go in the supine position and place the stethoscope bell over the Mitral region. A third and fourth heart sound gallop is heard during the diastole.

Summation Gallop at 120 beats per minute

The diastolic period is shortened when the heart is beating at the rate of 120 beats per minute. This leads to summation gallop. The third and fourth heart sounds get superimposed, and a single large sound is produced. This happens when the left ventricle is enlarged with decreased contraction in the left ventricle. The left atrium is also enlarged to some extent.

For auscultation, the patient should be in a supine position. To auscultate summation gallop, use the diaphragm of the stethoscope. Place the diaphragm over the mitral region and hear the sound. A single large sound is heard.

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