Triple And Quadruple Heart Sounds
Triple Heart Sound Or Gallop Rhythm
Triple heart sound or triple rhythm is an abnormal rhythm of heart, characterized by three clear heart sounds during each heart beat. It is due to an abnormal third or fourth heart sound that is heard besides first and second heart sounds. It is also called gallop rhythm, since it resembles the sound of a horse’s gallop. Usually, it is indicative of serious cardiovascular disease.
Conditions When Triple Heart Sound is Produced
Triple heart sound is produced in conditions like myocardial infarction and severe hypertension.
Quadruple Heart Sound
Quadruple heart sound is an abnormal rhythm of heart, characterized by four clear heart sounds during each heart beat. It is also called quadruple rhythm. It is due to third and fourth heart sounds that are heard besides first and second heart sounds. It is also called quadruple gallop. Quadruple heart sound is also indicative of serious cardiovascular disease.
Conditions When Quadruple Heart Sound Is Produced
Quadruple heart sound is produced in patients with congestive heart failure.
Whenever there is tachycardia in patients with quadruple heart sound, the third and fourth heart sounds merge. together and give rise to a single sound. This sound is called summation gallop and it resembles gallop rhythm.
Methods Of Study Of Heart Sounds
Heart sounds are studied by three methods:
- By using stethoscope
- By using microphone
- By using phonocardiogram
1- By Stethoscope
First and second heart sounds are heard on the auscultation areas, by using the stethoscope. The chest piece of the stethoscope is placed over four areas on the chest, which are called auscultation areas.
i. Mitral Area (Bicuspid area)
Mitral area is in the left 5th intercostal space, about 10 cm away from the midline (midclavicular line). Sound produced by the closure of mitral, valve (first heart sound) is transmitted well into this area. It is also called apex beat area because apex beat is felt in this area.
Apex beat is the thrust of the apex of ventricles, against the chest wall during systole.
ii. Tricuspid Area
Tricuspid area is on the xiphoid process. Sound produced by the closure of tricuspid valve (first heart sound) is transmitted well into this area.
iii. Pulmonary Area
Pulmonary area is on the left 2nd intercostal space, close to sternum. Sound produced by the closure of pulmonary valve (second heart sound) is heard well on this area.
iv. Aortic Area
Aortic area is over the right 2nd intercostal space, close to the sternum. On this area, the sound produced by the closure of aortic valve (second heart sound) is heard well. First heart sound is best heard in mitral and tricuspid areas. However, it is heard in other areas also but the intensity is less. Similarly, the second heart sound is best heard in pulmonary and aortic areas. It is also heard in other areas with less intensity.
2- By Microphone
A highly sensitive microphone is placed over the chest. The heart sounds are amplified by means of an amplifier and heard by using a loudspeaker. First, second and third heart sounds are heard by this method.
3- By Phonocardiogram
Phonocardiography is the technique used to record the heart sounds. Phonocardiogram is the graphical record of heart sounds. It is done by placing an electronic sound transducer over the chest. This transducer is connected to a recording device like polygraph. All the four heart sounds can be recorded in phonocardiogram. It helps to analyze the frequency of the sound waves.
Appearance Of Heart Sounds In Phonocardiogram
In phonocardiogram, the heart sounds are recorded in the following manner:
First Heart Sound
First heart sound is recorded as single group of waves. The waves are of small amplitude to start with. Later, the amplitude rapidly rises and falls to form crescendo and diminuendo series of waves. About 9 to 13 waves appear.
Second Heart Sound
Second heart sound appears as single group of waves, which have same amplitude. About 4 to 6 waves are recorded.
Third Heart Sound
Third heart sound is found in phonocardiogram with only 1 to 4 waves grouped together.
Fourth Heart Sound
Mostly, the fourth heart sound merges with first heart sound. If it appears as separate form, it has 1 to 2 waves with very low amplitude.