Third heart sound galloping horse rhythm

Introduction Early diastolic galloping refers to the pathological third heart sound, which is the sound produced by the extremely rapid filling of the early diastolic blood to the enlarged ventricle causing vibration of the wall or vibration of the atrioventricular valve, which is common in severe myocardial damage. Left heart failure, valve insufficiency, a large number of left to right shunts. The patient's left lateral position with a bell-shaped auscultation head is most clearly auscultated at the apex of the patient, and is a low-key voice. If it is a right heart disease, it should be the clearest auscultation at the lower left edge of the sternum. The pathological third sound tends to be called the galloping rhythm even if the heart rate is not fast. Also called ventricular galloping. Because it is actually a rhythm composed of pathological S3 and S1, S2, it is also called the third heart sound.

Cause

Common in heart failure, acute myocardial infarction, mitral regurgitation, hypertensive heart disease. It is generally believed that due to excessive ventricular overload in the diastolic phase, myocardial tension is reduced, and ventricular wall compliance is reduced. When the atrial blood is rapidly injected into the ventricle during early diastole, it causes vibration of the overfilled ventricular wall. Therefore, the appearance of galloping horse is an important sign of severe myocardial damage.

an examination

Related inspection

ECG heart sound map check

Characteristics of auscultation in early diastolic galloping:

1 tone is lower.

2 intensity is weak.

3 extra heart sounds appear in the early diastolic, that is, after the second heart sound.

4 galloping originated in the left ventricle, the clearest part of the auscultation is in the apex, while the right ventricle is the clearest in the left rim of the lower sternum.

5 left ventricular galloping rhythm is obvious at the end of the breath, weakened when inhaling, right ventricular galloping is obvious when inhaling, weakening when exhaling.

Differential diagnosis

1, heart sounds low blunt: refers to the low heart rate. Low heart bluntness is not necessarily morbid. When the chest wall is thick, obesity, etc., the auscultation heart sound can be low and blunt. In some cases, it can also occur, such as pericardial effusion, heart failure, shock, etc.

2, the first heart sound hyperthyroidism: left ventricular filling reduction in mitral stenosis, lower mitral valve position in the late diastolic, and second, due to decreased left ventricular blood volume, systolic period is correspondingly shortened, then the left ventricular pressure is rapid Ascending, the low-order mitral valve suddenly becomes tense and closes, thus producing a high-key and crisp first heart sound, which sounds like a slap, commonly referred to as the slap-first heart sound. In complete atrioventricular block, the atrial and ventricular beats are not related, forming a phenomenon of compartment separation. When the atrium and ventricle are simultaneously contracted, the first heart sound is extremely loud, usually called "cannon sound". ".

3, heart sounds far away: when the doctor uses a stethoscope for cardiac auscultation, if the first heart sound and the second heart sound are weak, heavy turbid, fuzzy and distant sense, the heart sound is far away. Patients are often forced to take a semi-recumbent position and lean forward. If they are supine, the heart sound is far more obvious.

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