GALLOP SOUNDS IN HYPERTENSION AND MYOCARDIAL ISCHAeMIA MODIFIED BY RESPIRATION AND OTHER MANOEUVRES

Open Access
Publisher Website
Google Scholar
Abstract
Alteration and disappearance of gallop sounds are important signs in assessing clinical improvement in hypertensive and ischemic heart disease. Protodiastolic gallop, due to an accentuated 3rd heart sound accompanying passive early diastolic ventricular filling, is known to be more ominous, while presystolic gallop, due to an accentuated atrial sound accompanying ventricular filling during atrial systole is more benign. The timing of the atrial sound is also of importance, for when the sound is early and thus relatively widely separated from the 1st heart sound, the prognosis is graver. We found that simple physiological maneuvers, such as respiration, posture, and exercise, profoundly modified the gallop sound in 25 patients with hypertensive and ischemic heart disease. The loudness and timing and indeed the presence of an atrial sound varied with the phases of respiration, with posture, and sometimes with exercise. Held expiration, which is the normal state in which a phonocardiograph is recorded, sometimes abolished the sound. Similarly sitting upright sometimes caused the sound to disappear. Venous cuffing and the intravenous injection of aminophylline also resulted in diminution or disappearance of the atrial sound. In two patients with quadruple rhythm we were able to vary the nature of their gallop by the same physiological maneuvers, converting quadruple rhythm to a lone 3rd heart sound, to an atrial sound, or abolishing both at will. Even normal quiet respiration was capable of producing these changes, thus emphasizing the importance of continuous respiration when recording the phonocardiogram. Because of the large variations in the gallop sounds with these simple physiological maneuvers, we feel that caution is necessary in interpreting relatively minor changes in gallop rhythm in relation to the clinical progress of the patient.