The S3 Gallop - Thoracic Key

A ventricular gallop sound is an extra heart sound. · S3 gallop is a low frequency, early to mid-diastolic sound. · In the normal heart during ... ThoracicKey FastestThoracicInsightEngine Home LogIn Register Categories CARDIACSURGERY CARDIOLOGY GENERAL RESPIRATORY VASCULARSURGERY MoreReferences AbdominalKey AnesthesiaKey BasicmedicalKey Otolaryngology&Ophthalmology MusculoskeletalKey NeupsyKey NurseKey Obstetric,GynecologyandPediatric Oncology&Hematology PlasticSurgery&Dermatology ClinicalDentistry RadiologyKey ThoracicKey VeterinaryMedicine About GoldMembership Contact Menu TheS3Gallop Fig.18.1 ArepresentativeEKGsignificantforQwavesinthelateralprecordialleadsandanSTelevationinV4 Anechocardiogram(Fig.18.2)wasconsistentwithfindingofanLVaneurysm.Ejectionfractionwas23%. Fig.18.2 Leftventricularaneurysmonanechocardiogram ClinicalBasics NormalAnatomy AnormalcardiacexamislimitedtoanS1andS2heartsounds,withS2splitoninspiration. Definitions Aventriculargallopsoundisanextraheartsound.Therearetwotypesofgallopsounds,S3andS4. S3gallopisalowfrequency,earlytomid-diastolicsound. Inthenormalheartduringnormalsinusrhythm,diastolicfillingoftheventricleacrosstheatrioventricularvalvesoccursintwophases,earlyandatrialfilling.TherearecharacterizedbyDopplerechocardiography: EwaveisthecharacteristicwaveseenonDopplerrelatedtopassivefillingoftheventricle. AwaveisactivefillingwithatrialsystoleseenonDoppler. EandAwavesrepresentingmitralflowinahealthyheart(E > A).EwaveisclassicallygreaterthanAwavesincepassivefillingencompasses80%.Inconditionsthatlimitventricularcompliancetwoabnormalitiesarepossible: reversal–inwhichtheAwaveisgreaterthantheEwave.Thisindicatesslowfillingcausedbyolderage,hypertension,leftventricularhypertrophy(LVH),ordiastolicdysfunction. exaggerationofnormal–atall,thinEwavewithasmallorabsentAwave.Thisindicatesrestrictivecardiomyopathy,constrictivepericarditis,orinfiltrativecardiacdisease[1–3]. Etiology Therearetwophasesofventricularfilling.Tostartthefirstphase,ventricularbloodpressuredropssufficientlytoallowtheopeningoftheAVvalves.Bloodrapidlyflowsfromtheatriumtotheventriclescomprising80%offilling.Therecipientventricleactivelyrelaxestoaccommodatetheincreasedvolume.TherapiddecelerationofbloodasithitstheventriclescanproduceaprotodiastolicsoundscalledS3.S3canbephysiologicinchildrenandyoungadultsorpathologic.Inpathologiccases,theventriclesarestiffduetoheartfailureorstructuralheartdisease[1].SeeFig.18.3. Fig.18.3 Progressionofstructuralheartdiseasethatleadstothedevelopmentofthethirdheartsound ThesoundisheardaftertheEwave(ventricularfilling)duetorapidEwavedecelerationduetoanon-compliantheart.Allheartbeatscausetheseoscillations,butonlysomehavethecorrectfrequencyandintensitytobeasaudibleasanS3[1,2].Atincreasedheartrates,thetimingoftheS3relativetothestartofthenextcardiaccycleshortens,leadingtoacharacteristicheartsoundsof“buh-buh-buh,buh-buh-buh.”SeeFig.18.4. Fig.18.4 Multipleoscillationsinthecardiacbloodpool,includingtheS3soundinearlydiastole.Atincreasedheartrates,thetimingoftheS3relativetothestartofthenextcardiaccycleshortens,leadingtoacharacteristicheartsoundsof“buh-buh-buh,buh-buh-buh” Ewavedecelerationresultsinlossoffluidkineticenergyandcardiohemicoscillations.DifferencescanbeseeninthisbetweenpathologicandphysiologicS3.SeeFig.18.5. Fig.18.5 (a)SeveralconsecutivebeatsofthephonocardiogramfromavolunteerwithoutanaudibleS3.Fortheuntrainedobserver,S3featuresaredifficulttodiscernfrombaselinenoise.(b)Filtered,averagedlogpowerofthephonocardiogramabove.NoteclearS3featureforeachcardiaccycle,althoughnoS3couldbeheard.(c)SimultaneousDopplerprofile,E-wavecontour,phonocardiogram,andmodel-predictedS3fortheheartbeatinaindicatedbythearrow.E-waveparameters:xo = −11.2 ± 0.6cm,c = 12.6 ± 1.9g/s,andk = 214 ± 7g/s2.S3modelparameters:C = 50g/s,μ/S = 0.5%,andΔx = 0.2cm.PDFindicatesparameterizeddiastolicfilling(UsedwithpermissionfromMansonetal.[2]) PhysiologicS3arisefromhigherEwavevelocities. PathologyS3arisefromsteeperEwavedeceleration[2]. SignsandSymptoms CommoncardiacfindingsassociatedwithanS3include: Highleftatrialpressure. Noncompliantleftventricle. Restrictivefillingcharacteristics. ReducedLVsystolicfunction(alsoindiastolicdysfunction). Whenpresent,valvulardiseaseismorelikelytobesevere[3]. Prevalence PhysiologicS3isuncommonafter35–40yearsofage[1]. PathologicS3: IntheSOLVDtreatmenttrial,23.9%ofthosewithestablishedCHFandEF  Onlygoldmemberscancontinuereading.LogInorRegistera>tocontinue YoumayalsoneedAorticStenosisAtrialSeptalDefectMitralRegurgitationTricuspidValve:TricuspidRegurgitationFlailMitralLeafletMitralStenosisDynamicAuscultationPatentDuctusArteriosus Sharethis:ClicktoshareonTwitter(Opensinnewwindow)ClicktoshareonFacebook(Opensinnewwindow)ClicktoshareonGoogle+(Opensinnewwindow) Related Tags:LearningCardiacAuscultation Jul10,2016|PostedbyadmininCARDIOLOGY|CommentsOffonTheS3Gallop PremiumWordpressThemesbyUFOThemes WordPressthemebyUFOthemes