Listening Beyond Lub-Dub: Exploring the Significance of S3 and S4 Heart Sounds

Welcome to this extra heart sounds category, which 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 minute.

The third heart sound (S3) occurs during the rapid filling period of early diastole, while the fourth heart sound (S4) ensues in late diastolic periods just before the first heart sound. Before taking this session, it is recommended that you have finished the normal heart sounds session, as well as the first and second heart sound sessions. You should feel confident in your ability to listen and be familiar with normal heart sounds.

For optimal listening, please use good quality headphones or earphones, as computer or phone speakers may not reproduce some heart sounds accurately.

The third heart sound (S3), also known as the “ventricular gallop,” occurs just after the second heart sound when the mitral valve opens, allowing the passive filling of the left ventricle. The third heart sound is produced by a large amount of blood flowing into a very compliant 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 practice, accurate diagnosis and understanding of the case are crucial. Therefore, it is important to be able to hear the sounds correctly and identify any abnormalities during auscultation.

Prior practice with the sounds is beneficial, as familiarity can improve performance. This site is a valuable resource for gaining practice in auscultation and learning about different cases. Practice as much as you want to gain self-confidence and prepare for future medical practice.

This site is always available as a helpful friend to aid you in learning about heart sounds.

Third Heart Sound Gallop

The third heart sound, also known as S3, is a low-pitched sound that can sometimes be heard during a physical examination of the heart. It occurs after the second heart sound, or S2, and is sometimes referred to as a “gallop” rhythm because it can sound like the cadence of a galloping horse.

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The S3 sound is caused by the vibration of the ventricular walls as blood flows into the ventricles during diastole, the relaxation phase of the cardiac cycle. It is often associated with conditions that cause increased filling pressures in the ventricles, such as heart failure.

The presence of an S3 sound can be a useful diagnostic tool for healthcare professionals in detecting heart failure, particularly in patients with symptoms such as shortness of breath, fatigue, and edema. However, it is important to note that not all patients with heart failure will have an S3 sound, and its absence does not necessarily rule out the condition.

Overall, the third heart sound or S3 is an important clinical finding that can provide valuable information about a patient’s heart health and should be carefully evaluated in the context of the patient’s medical history and other clinical findings.

A third heart sound (S3) is a low-frequency sound that occurs during early diastole, after the second heart sound. It is caused by the vibration of blood against the ventricular wall during the rapid filling phase of the ventricles. The S3 is considered a normal finding in children and young adults but can indicate heart failure in older adults.

The term “gallop” was used to describe the presence of three heart sounds occurring in quick succession, which includes the S3. This completes the triple rhythm of the heart, and it is a valuable diagnostic sign.

Auscultation of the S3 can be challenging, and it requires a skilled practitioner to identify it correctly. The sound is very faint and can easily be obscured by external sounds and lung sounds. The S3 has minimal radiation capacity, and it can only be heard in specific areas.

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To improve the detection of the S3 gallop, the examiner should raise the bed to a comfortable level and have the patient lie on their left side. This position shifts the heart closer to the chest wall, making it easier to hear the S3 sound. In addition, using a high-quality stethoscope with a bell attachment can improve the detection of the S3 gallop.

Fourth Heart Sound Gallop

The fourth heart sound is also known as S4 or atrial gallop. It is an abnormal heart sound that occurs during diastole, just before the first heart sound (S1). The S4 sound is typically heard as a low-pitched sound that resembles the sound “Tennessee”.

The S4 sound is caused by the contraction of the atria as they push blood into the ventricles. This occurs just before the ventricles contract, and is often a sign of decreased ventricular compliance, which means the ventricles are less able to expand and fill with blood during diastole. This can be a sign of various heart conditions such as left ventricular hypertrophy, ischemic heart disease, or heart failure.

The presence of S4 can be detected during a physical examination using a stethoscope. Treatment of S4 depends on the underlying condition causing it, and may involve medications, lifestyle changes, or surgery.

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 sounds, also known as gallops, are additional sounds that can be heard during cardiac auscultation. They are known as gallops because they sound like a horse’s gallop.

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The third heart sound (S3) occurs during the rapid filling phase of the ventricles, which happens during early diastole. It is often heard in younger individuals and athletes, but can also be a sign of heart failure in older individuals. The S3 is best heard with the bell of the stethoscope placed at the apex of the heart in the left lateral decubitus position.

The fourth heart sound (S4) occurs just before the first heart sound (S1) during late diastole when the atria contract and force blood into the ventricles. It is often associated with hypertension, aortic stenosis, and other conditions that cause stiffening of the ventricular walls. The S4 is best heard with the bell of the stethoscope placed at the apex of the heart in the left lateral decubitus position.

Both the third and fourth heart sounds are considered abnormal if they are present in patients over the age of 40 and can be an indication of underlying heart disease. They are important to recognize and evaluate during a cardiac exam as they can provide important diagnostic information.

Summation Gallop at 120 beats per minute

When the heart beats at a rate of 120 beats per minute, the diastolic period, which is the time between heart contractions, is shortened. This can result in a phenomenon called summation gallop, where the third and fourth heart sounds become superimposed, creating a single large sound. Summation gallop is typically observed in individuals with an enlarged left ventricle and decreased contraction in this chamber, as well as some degree of enlargement of the left atrium.

To properly auscultate summation gallop, the patient should be in a supine position. Using the diaphragm of the stethoscope, place it over the mitral region and listen for the sound. You should be able to hear a single, large sound.

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