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The 3rd heart sound is associated with atrial fibrillation and mitral valve regurgitation (otherwise known as incompetence). It is low-pitch in nature, and can cause what is termed a ‘gallop rhythm’.
Whilst it is a normal variant in children and young adults, if found in patients over the age of 40-years, should be further investigated. It is also present in high output states.
The 4th heart sound is a low-pitched heart sound, caused by contracted against a less than compliant ventricle in pre-systole. It is rarely associated with a normal heart, except when first degree heart block is present. It is at its peak in the left lateral position, with the bell.
It can be normal if there is a 1st degree heart block i.e. prolonged P-R interval.
If there is an associated tachycardia, then it can be difficult to discern between the different heart sounds.
The presence of both a 3rd and 4th heart sound is known as a gallop rhythm, and can be associated with pulmonary hypertension, among other conditions that can cause a 3rd and 4th heart sound.
Conditions associated with a 4th heart sound:
- hypertensive heart disease
- aortic stenosis
- left ventricular hypertrophy
- heart failure
- acute myocardial infarction
- ischaemic heart disease
- restrictive cardiomyopathy
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Question 1 of 5
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What is the diagnosis?CorrectIncorrect
Question 2 of 5
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How do you describe the presence of both a 3rd and a 4th heart sound?
Question 3 of 5
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The presence of a 3rd heart sound is always pathological. True or false?CorrectIncorrect
Question 4 of 5
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Which of the following is associated with a 3rd heart sound?CorrectIncorrect
Question 5 of 5
5. Question1 point(s)
The rhythm of a 3rd heart sound sounds like which of the following words?CorrectIncorrect