The clinical significance of cardiac gallop rhythm

1. 1. On logarithmic phonocardiography of 100 cardiac patients, protodiastolic (third sound) gallop rhythm was recorded in 15, presystolic (fourth sound) gallop rhythm in 10, and train-wheel rhythm (third and fourth sounds) in 4. 2. 2. Protodiastolic gallop was associated with right heart strain, and presystolic gallop and train-wheel rhythm with left heart strain or myocardial damage. These phenomena were not related to the age, sex, or heart rate of the patients or to the presence of cardiac failure. In patients with mitral stenosis protodiastolic gallop was commoner when there was associated aortic incompetence. 3. 3. In the whole series, patients with a fourth heart sound (presystolic gallop or train-wheel rhythm) showed significant deterioration relative to the other patients after 6 to 9 months. Of the patients with mitral stenosis and aortic incompetence only those with protodiastolic gallop rhythm showed significant deterioration. 4. 4. There was no significant correlation between the patients' condition after 25 to 34 months and the presence or absence of gallop or train-wheel rhythm at the original investigation. These findings show that gallop rhythm is not of such grave prognostic significance as has sometimes been believed.