From the Guidelines
A gallop heartbeat is a significant clinical finding that indicates cardiac dysfunction, particularly heart failure, and requires prompt evaluation and management. It occurs when extra heart sounds (S3 or S4) are heard in addition to the normal S1 and S2, creating a rhythm that resembles a galloping horse. According to the European Society of Cardiology guidelines 1, a third heart sound (gallop rhythm) is a specific sign of heart failure. An S3 gallop suggests volume overload and ventricular dysfunction, commonly found in heart failure, while an S4 gallop indicates decreased ventricular compliance often seen in hypertension, coronary artery disease, or aortic stenosis.
Clinical Significance
The clinical significance of a gallop heartbeat lies in its association with cardiac dysfunction and heart failure. As outlined in the ESC guidelines 1, symptoms and signs such as breathlessness, orthopnoea, and fatigue are typical of heart failure, and the presence of a gallop rhythm can help confirm the diagnosis. The guidelines emphasize the importance of obtaining objective evidence of a structural or functional cardiac abnormality to secure the diagnosis of heart failure.
Management
Management of a gallop heartbeat focuses on treating the underlying cause, typically heart failure, with a goal of reducing morbidity, mortality, and improving quality of life. This includes:
- Diuretics to reduce fluid overload
- ACE inhibitors or ARBs to reduce afterload
- Beta-blockers to improve cardiac function
- Aldosterone antagonists in appropriate cases
- Restricting sodium intake and limiting fluid intake
- Daily weight monitoring to track fluid status
As noted in the guidelines 1, persistence of symptoms despite treatment usually indicates the need for additional therapy, and worsening of symptoms is a serious development that merits prompt medical attention. Therefore, prompt evaluation and management of a gallop heartbeat are crucial to prevent adverse outcomes and improve patient outcomes.
From the Research
Description of a Gallop Heartbeat
- A gallop heartbeat, also known as a gallop rhythm, is a type of abnormal heartbeat that can be heard with a stethoscope 2, 3, 4, 5, 6.
- It is characterized by a third heart sound, which is a low-frequency sound that occurs shortly after the second heart sound.
- A gallop heartbeat can be a sign of heart failure, as it indicates that the heart is having trouble pumping blood efficiently.
Clinical Significance
- The clinical significance of a gallop heartbeat is that it can be a indicator of underlying heart disease, such as heart failure or coronary artery disease 2, 3, 4.
- Studies have shown that patients with heart failure who have a gallop heartbeat are at increased risk of mortality and hospitalization 3, 4.
- The presence of a gallop heartbeat can also be a sign of other conditions, such as anemia, thyrotoxicosis, or pulmonary embolism.
Management
- The management of a gallop heartbeat depends on the underlying cause of the condition 2, 3, 4, 5, 6.
- Treatment may include medications such as ACE inhibitors, beta blockers, and diuretics to help manage heart failure and reduce symptoms.
- In some cases, a gallop heartbeat may be a sign of a more serious underlying condition, such as heart failure, and may require hospitalization and more aggressive treatment.
- Studies have shown that the use of ACE inhibitors can reduce mortality and hospitalization in patients with heart failure, and can also prevent myocardial infarction 2, 4, 6.