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Listening with a stethoscope (also known as auscultation) to all four areas of the heart: aortic, pulmonic, tricuspid and mitral. Any murmurs, rubs or gallops should be noted. Gallops are also known as a third (S3) or fourth (S4) heart sound. The absence of abnormalities (normal) may be recorded as "no m/r/g".
The third heart sound, or S 3 is rarely heard, and is also called a protodiastolic gallop, ventricular gallop, or informally the "Kentucky" gallop as an onomatopoeic reference to the rhythm and stress of S1 followed by S2 and S3 together (S1=Ken; S2=tuck; S3=y). [2] "lub-dub-ta" or "slosh-ing-in" If new, indicates heart failure or volume overload.
A gallop rhythm refers to a (usually abnormal) rhythm of the heart on auscultation. [1] It includes three or four sounds, thus resembling the sounds of a gallop . The normal heart rhythm contains two audible heart sounds called S 1 and S 2 that give the well-known "lub-dub" rhythm; they are caused by the closing of valves in the heart.
If S4 S1 S2 S3 Also known as a gallop rhythm. diastolic murmurs (e.g. aortic regurgitation, mitral stenosis) systolic murmurs (e.g. aortic stenosis, mitral regurgitation) pericardial rub (suggestive of pericarditis) The base of the lungs should be auscultated for signs of pulmonary oedema due to a cardiac cause such as bilateral basal crepitations.
Murmurs are of various types and are important in the detection of cardiac and valvular pathologies (i.e. can be a sign of heart diseases or defects). There are two types of murmur. A functional murmur is a benign heart murmur that is primarily due to physiologic conditions outside the heart.
Systolic heart murmurs are heart murmurs heard during systole, [1] [2] [3] i.e. they begin and end between S1 and S2. Many involve stenosis of the semilunar valves or regurgitation of the atrioventricular valves .
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The fourth heart sound or S 4 is an extra heart sound that occurs during late diastole, immediately before the normal two "lub-dub" heart sounds (S 1 and S 2).It occurs just after atrial contraction and immediately before the systolic S 1 and is caused by the atria contracting forcefully in an effort to overcome an abnormally stiff or hypertrophic ventricle.