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The cardiovascular system
Published in Peter Kopelman, Dame Jane Dacre, Handbook of Clinical Skills, 2019
Peter Kopelman, Dame Jane Dacre
Gallop rhythm A gallop rhythm means that there are three heart sounds to the cycle, and that the extra one is either a third sound or an atrial (fourth) sound. The noises heard sound rather like Kentucky (‘ken-tuc-kee’). At rapid heart rates, the third heart sound and atrial sounds may coincide, and a summation gallop is then heard – the noise suggests Tennessee (‘ten-nes-see’). In clinical practice, this suggests impaired ventricular function.
Pressure waveforms in the cardiac cycle
Published in John Edward Boland, David W. M. Muller, Interventional Cardiology and Cardiac Catheterisation, 2019
John Edward Boland, David W. Baron
A third or fourth heart sound is referred to as an added or extra sound, and these occur during diastole. The third heart sound is less distinct and represents the end of the rapid filling phase of the ventricular filling period in early diastole (just prior to the beginning of diastasis) and is thought to result from vibrations of the ventricular wall. The fourth heart sound occurs before the first and is caused by atrial systole into a poorly compliant left ventricle. Extra heart sounds are always abnormal, apart from the third which may be normal in children. The combination of an extra heart sound in a patient with tachycardia is called a gallop rhythm.
Practice Paper 4: Answers
Published in Anthony B. Starr, Hiruni Jayasena, David Capewell, Saran Shantikumar, Get ahead! Medicine, 2016
Anthony B. Starr, Hiruni Jayasena, David Capewell
A gallop rhythm is heard when the first (S1) and second (S2) heart sounds are followed by a pathological third (S3) and/or fourth (S4) heart sound. It is most commonly associated with left ventricular failure. When this rhythm is associated with tachycardia, the heart sounds cannot be individually distinguished and therefore ‘summate’ into a single sound. The third heart sound occurs in early diastole, and is caused by the rush of blood entering the ventricle as it relaxes. The presence of a third heart sound can be a normal finding in those below 40 years of age, but when pathological is associated with cardiac failure, mitral regurgitation and dilated cardiomyopathy. On auscultation, the presence of a third heart sound is thought to resemble the phonetic pronunciation of the word ‘Kentucky’.
Assessing congestion in acute heart failure using cardiac and lung ultrasound - a review
Published in Expert Review of Cardiovascular Therapy, 2021
Øyvind Johannessen, Peder L. Myhre, Torbjørn Omland
The physical signs in congested AHF involve jugular vein distension (JVD), peripheral edemas with or without pitting, along with ‘crackles’ and ‘rales’ on lung auscultation. A typical third heart sound (S3) or ‘gallop’ rhythm is also common. With hemodynamic congestion defined as PCWP ≥ 18 mmHg, history, symptoms, and findings have poor predictive value for elevated PCWP. Dyspnea on exertion, orthopnea, edema, resting JVD, and S3 have been demonstrated to correlate poorly with congestion, with sensitivities ranging from 46% to 73%. The best accuracy was seen for S3 (sensitivity 73% and specificity 42%) and JVD (sensitivity 70% and specificity 79%) [20,22]. The ESCAPE trial found that the only parameters that were associated with elevated PCWP ≥ 18 mmHg were JVD and orthopnea [23]. Long-term invasive monitoring in HF patients with implantable cardiac devices shows that raised intra-cardiac pressures precedes physical signs of congestion. This discrepancy between actual hemodynamic congestion and overt signs and symptoms may explain the poor accuracy of the physical findings for elevated cardiac pressures [20,24,25].
Myeloperoxidase, a possible biomarker for the early diagnosis of cardiac diastolic dysfunction with preserved ejection fraction
Published in Journal of Enzyme Inhibition and Medicinal Chemistry, 2018
Bogdan Ioan Coculescu, Gabi Valeriu Dincă, Constantin Bălăeţ, Gheorghe Manole, Maria Bălăeţ, Cristina Mariana Stocheci
On the next stage of positive diagnosis establishment, for the selection of the required study sample, in the conditions of confirmed normal ejection fraction values and absence of any associated diseases, excluding of course the ischaemic cardiopathy, the LV diastolic function was assessed, practically the existence of DD. The DD diagnosis was made on the base of the following 3 obligatory criteria given by the European Study Group on Diastolic Heart Failure:Signs and symptoms of CI: • Symptoms: dyspnoea and/or arterial hypertension during effort states. • Signs: gallop rhythm, respiratory sounds – pulmonary crepitation and even acute pulmonary oedema.Normal or slightly affected systolic function.Abnormalities in diastolic relaxation, filling, distensibility, or stiffness17,18.
Sacubitril/valsartan treatment improved the clinical outcome and reduced the hospitalization rate in three patients with chronic heart failure: a case series
Published in Current Medical Research and Opinion, 2019
Donatella Severini, Kwame Mboumi
In May 2017, the patient was admitted to the emergency room with asthenia, dyspnoea with moderate exertion and a cough, which had arisen for a few weeks, 20 days after smoking cessation. The patient was diagnosed with “new-onset” HF with New York Heart Association (NYHA) functional class II, and was hospitalized in the cardiology unit. Clinical examination showed mild postural oedema, gallop rhythm and a heart rate of 95 bpm. The electrocardiogram (ECG) examination showed evidence of hypertrophy and left ventricular overload. At echocardiography, left ventricular end-diastolic dimension (LVEDD) was 66 mm, indicating dilation, with normal wall thickness and left ventricular ejection fraction (LVEF) was severely reduced to 28%. Mild mitral insufficiency was found, and the left atrium was slightly dilated. The inferior vena cava (IVC) diameter was 20 mm, with <50% motility. Estimated pulmonary arterial pressure was 35 mmHg. At chest radiography the cardiac silhouette was enlarged, prevalently on the left ventricle. The values of blood examinations were normal (e.g. N-terminal prohormone of brain natriuretic peptide [NT-proBNP] = 21 pg/ml). After coronary angiography that revealed no alterations of the coronary arteries, the diagnosis of new-onset HF, NYHA class II and dilated cardiomyopathy with undamaged coronaries was confirmed and the patient was discharged, after 1 week of hospitalization, with the following therapeutic plan:Ramipril 2.5 mg qdBisoprolol 1.25 mg qdFurosemide 25 mg qdPotassium canrenoate 25 mg qdL-thyroxine 100 μg qd