Atrial gallop


Atrial gallop

Description, Causes and Risk Factors:

Gallop cadence in which the gallop sound in late diastole is an audible fourth heart sound due to forceful ventricular filling following atrial systole.

Atrial gallop

An atrial gallop is a low-pitched sound that originates from left atrial contraction and is best heard with the bell of the stethoscope pressed lightly against the cardiac apex. It is best heard before the first heart sound (S1), late in diastole.

An atrial gallop is produced by a fourth heart sound, called S4. It's another low-pitched sound heard best over the apex. However, S4 is heard late in diastole, just prior to S1. S4 is normal in infants and children and common in the elderly. In adults, however, S4 often occurs after myocardial infarction. S4 is also linked to aortic stenosis, myocardial ischemia, heart failure, and hypertension. It's caused when stiff and over-distended ventricles are forced to accept blood from the atria during late diastole, when the atria exert their final squeeze, called the atrial kick.

Risk factors:

    Hypertrophy of the ventricle.

  • Long-standing hypertension.

  • Aortic stenosis.

  • Overloading of the ventricle.

  • Fibrosis of the ventricle.

Symptoms:

    Atrial gallop is accompanied by a soft, short diastolic murmur along the left sternal border.

  • S2 may be soft or absent and a soft short midsystolic murmur may be heard over the second right intercostals space.

  • Other signs and symptoms include tachycardia, dyspnea, JVD (jugular vein distention), crackles, cool extremities, tachycardia, tachypnea, and angina.

Diagnosis:

Suspect myocardial ischemia if you auscultate an atrial gallop in a patient with chest pain. Check the patient's vital signs and assess for signs of heart failure. If you detect these signs, attach the patient to a cardiac monitor and obtain an electrocardiogram to assess the patient's cardiac status. When the patient's condition permits, ask about a history of hypertension, angina, valvular stenosis, or cardiomyopathy.

Treatment:

The main goals of treatment of atrial gallop are to prevent temporary circulatory instability and to prevent stroke. Anticoagulation may be required to decrease the risk of the latter while rate and rhythm control are principally used to achieve the former. When circulatory collapse is imminent in emergency cases due to uncontrolled tachycardia, immediate cardioversion may be indicated. If rate and rhythm control of the atrial gallop cannot be maintained by medication or cardioversion, electrophysiological studies with pathway ablation may be required.

NOTE: The above information is for educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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