Gallop (S3/S4)

Definition

A gallop is an additional heart sound (S3 or S4) heard during auscultation that creates a 'galloping' rhythm. S3 and S4 occur during diastole and often indicate cardiac dysfunction.

S3 (Ventricular Gallop)

Occurs early in diastole during rapid ventricular filling. May be normal in children, athletes, and pregnant women, but in adults over 40 it strongly suggests HEART FAILURE. Sounds like 'Ken-TUC-ky.' Heard best at apex with the bell, patient in left lateral position.

S4 (Atrial Gallop)

Occurs late in diastole as the atrium contracts against a stiff ventricle, such as associated with hypertension, left ventricular hypertrophy, aortic stenosis, and ischemia. Sounds like 'TEN-nes-see.'

Nursing Considerations

Document new gallops immediately. They often precede overt heart failure. Assess for associated signs (crackles, JVD, edema, dyspnea). Review cardiac history, meds (diuretics, beta-blockers, ACE inhibitors).

NCLEX Relevance

S3 in an adult = fluid overload/CHF. S4 = ventricular hypertrophy.