12 Gallop rhythm
Salient features
Examination
• Presence of an abnormal third or fourth heart sound (Fig. 12.1) with tachycardia. (The presence of a normal third or fourth heart sound does not connote a gallop rhythm unless there is associated tachycardia.)
• Auscultate with the bell as third and fourth heart sounds are low pitched
• Gallop rhythm as a result of third heart sound seems to sound like ‘Kentucky’, whereas that because of the fourth heart sound sounds like ‘Tennessee’.
Notes
• A left ventricular third heart sound is best heard at the apex, whereas the right ventricular third heart sound is best heard along the left sternal border.
• The left ventricular third heart sound is heard over the left ventricular impulse, especially when the impulse is brought closer to the chest wall by placing the patient in a partial left lateral decubitus position.
• In emphysematous patients, the gallop is better heard when listening over the xiphoid or epigastric area.
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