Galloping heart sound

Introduction The normal adult heart beat has two heart sounds, called the first heart sound and the second heart sound. The galloping rhythm is the rhythm of the additional heart sound that appears after the second heart sound, combined with the original first and second heart sounds. It is like the sound of horseshoes touching the ground when the horse runs, so it is called the galloping horse. According to the different time of the occurrence of galloping, it can be divided into early diastolic galloping, diastolic late galloping and overlapping galloping, which is the most common early diastolic galloping, which appears after the second heart sound 0.12-0.18 Within seconds; late diastolic gallopism occurs later, before the start of systole, which is 0.1 second before the first heart sound, so it is also called systolic galloping; when there is simultaneous diastolic early gallop and diastolic late horse At the time of the law, plus the first heart sound and the second heart sound, it sounds like four sounds that occur in parallel, also known as "four temperament", "the locomotive runs the horse". It is generally believed that early diastolic galloping is caused by excessive ventricular diastolic load, decreased myocardial tension and decreased compliance, so that when the ventricle is dilated, blood filling causes wall vibration. Therefore, the appearance of galloping horse is an important sign of severe myocardial damage.

Cause

Coming horse is due to excessive ventricular diastolic load, decreased myocardial tension and decreased compliance, so that when the ventricle is dilated, blood filling causes wall vibration. Therefore, the appearance of galloping horse is an important sign of severe myocardial damage.

Gallop rhythm: For the extra heart sound that appears after the second heart sound, the rhythm combined with the original first and second heart sounds is similar to the sound of the horseshoe when the horse runs, so it is called the galloping horse. . According to the time of appearance, the running horse can be divided into three types.

The appearance of early diastolic galloping has important clinical significance, reflecting left ventricular dysfunction, diastolic volume overload, and severe myocardial function disorder. Running horse is one of the important signs of severe myocardial damage. After treatment, the galloping can disappear after the heart function is improved. The disappearance of clinical galloping can be used as one of the signs of improvement.

The appearance of late diastolic gallopema reflects excessive ventricular systolic load, decreased wall compliance, and more common in heart disease caused by excessive ventricular hypertrophy, such as hypertensive heart disease, hypertrophic cardiomyopathy, aortic valve Stenosis, pulmonary stenosis, etc.

When there are simultaneous early diastolic and diastolic galloping, the auscultation is "ke-len-da-la" 4 sounds, like the sound of the wheel in the locomotive, called quadruple rhythm, also known as "quadruple rhythm" The locomotive "runs the horse. When the heart rate is increased (>120 beats/min), the extra heart sounds of the early diastolic and late diastolic gallops overlap, called the overlapping gallop (three temperament). When the heart rate slows down, it returns to the four temperament. Common in patients with cardiomyopathy, left heart or right heart failure with tachycardia.

an examination

Related inspection

Electrocardiogram Doppler echocardiography dynamic electrocardiogram (Holter monitoring)

(1) Holter: Also known as long-term electrocardiogram, it provides information on the subject's full-day dynamic ECG activity. Effectively supplementing the deficiencies of conventional ECG, not only can you obtain ECG data for 24 hours or even 48 hours in a row, combined with the patient's activity diary, you can also determine the relationship between the patient's symptoms, activity status and medications and changes in ECG.

(B) echocardiography: commonly known as heart B ultrasound. Echocardiography uses the characteristics of radar scanning technology and acoustic reflection to display the reflection of ultrasonic waves through the layers of the heart on the screen to form a gray-scale image, so as to observe the morphological structure and pulsation state of the heart and large blood vessels, and to understand the atrioventricular contraction. The rules of diastolic and valve closure and open activity provide clinically valuable reference materials.

Differential diagnosis

It is a type of heart disease and needs to be diagnosed together with other symptoms. Rheumatic mitral regurgitation, rheumatic mitral stenosis, infective endocarditis, rheumatoid heart disease, systemic lupus erythematosus, aortic regurgitation, Austin-Flint murmur, left atrial fluid tumor mitral valve Large neoplasms or thrombosis, constrictive pericarditis, Hurler syndrome, patent ductus arteriosus, Lutembacher syndrome, severe mitral regurgitation, severe aortic regurgitation, large ventricular septal defect, hypertensive heart Aortic coarctation, dilated cardiomyopathy, anaemia, hyperthyroidism, third degree atrioventricular block. Diastolic murmur in the apical region caused by other causes.

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