Four-tone rhythm

Introduction The four-tone rhythm, also known as the locomotive gallop, means that the pathological third heart sound and the fourth heart sound appear simultaneously, that is, there are two additional heart sounds during the diastole, which together with the first and second heart sounds constitute a four-tone rhythm. There are two additional heart sounds during diastole, which together with the first and second heart sounds form a four-tone rhythm. If the heart rate is easy to hear when it is 100~110 times/min, its rhythm is like the sound of the wheel colliding with the rail when the train is running, so it is also called the locomotive.

Cause

The pathological third heart sound and the fourth heart sound appear simultaneously, that is, there are two additional heart sounds in the diastolic phase, and together with the first and second heart sounds constitute a four-tone rhythm.

There are two additional heart sounds during diastole, which together with the first and second heart sounds form a four-tone rhythm. If the heart rate is easy to hear when it is 100~110 times/min, its rhythm is like the sound of the wheel colliding with the rail when the train is running, so it is also called the locomotive. If the heart rate is further increased to 120-130 times/min, the diastolic period is shortened, and the pathological third and fourth heart sounds are close to overlap, especially when the atrioventricular block (prolonged PR interval) is combined, the atrial contraction falls in the ventricle. During the rapid filling period, the rapid filling of the ventricle is accelerated, and the fourth heart sound and the third heart sound are superimposed and changed. In the middle of the diastole, a very loud single sound appears, which is called overlapping galloping. If the carotid sinus is pressed to slow the heart rate, the overlapping gallops will separate and restore the four-tone rhythm.

an examination

Related inspection

Doppler echocardiography dynamic electrocardiogram (Holter monitoring)

There are two additional heart sounds during diastole, which together with the first and second heart sounds form a four-tone rhythm. If the heart rate is easy to hear when it is 100~110 times/min, its rhythm is like the sound of the wheel colliding with the rail when the train is running, so it is also called the locomotive. If the heart rate is further increased to 120-130 times/min, the diastolic period is shortened, and the pathological third and fourth heart sounds are close to overlap, especially when the atrioventricular block (prolonged PR interval) is combined, the atrial contraction falls in the ventricle. During the rapid filling period, the rapid filling of the ventricle is accelerated, and the fourth heart sound and the third heart sound are superimposed and changed. In the middle of the diastole, a very loud single sound appears, which is called overlapping galloping. If the carotid sinus is pressed to slow the heart rate, the overlapping gallops will separate and restore the four-tone rhythm.

Differential diagnosis

Pay attention to the identification of various heart sounds:

1. The third heart sounds galloping horses: Diastolic early galloping refers to the pathological third heart sound, which is caused by the extremely rapid filling of the early diastolic blood to the enlarged ventricle, causing vibration or vibration of the chamber wall. Sound, 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.

2. The first heart sound hyperthyroidism: the left ventricular filling is reduced in the mitral stenosis, the mitral valve position is lower in the late diastolic, and second, the systolic period is shortened due to the decrease of the left ventricular blood volume, and 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". ".

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