Gallop rhythm R00.8

A gallop rhythm is understood to be the occurrence of a pathological 3rd or 4th heart sound. However, simple tone splits do not count as such (Herold 2022 / Michel 1968).

One differentiates with the gallop rhythm between:

- Third tone gallop rhythm

This is a protodiastolic tone, which occurs early diastolic and arises during ventricular filling by vibration of the ventricular wall. Auscultation is over the apex of the heart, where the tone can be auscultated at low frequency. In children and adolescents, this tone may be physiologic (Thomsen 2018).

- Fourth- tone gallop rhythm.

This is where a presystolic atrial tone occurs. This is produced by atrial tension. The fourth tone leads to a prolongation of the PQ- time in the ECG. This tone may also be physiological in children and adolescents (Thomsen 2018).

- Summation gallop rhythm

A summation gallop rhythm is said to occur when both a 3rd and a 4th heart sound are present. A quadrhythm is formed together with the valve closure tones. This can merge into a so-called summation gallop rhythm at an increased heart rate (Thomsen 2018).

The gallop rhythm is physiological in children and adolescents when it occurs protodiastolically. However, it can also occur in the context of many underlying diseases, such as:

- heart failure

- myocarditis

- endocardial fibroelastosis

- univentricular AV-connection

- sepsis

- renal insufficiency

- glycogen storage disease type II, Pompe

- total pulmonary malocclusion

- truncus arteriosus (Michalk 2021)

- Mitral valve regurgitation (Thomsen 2018).

The therapy depends on the triggering underlying disease.

In 1960, Mohr, together with several authors, assessed the occurrence of a gallop rhythm as a prognostically unfavorable sign.

Ganten (2013) also describes the occurrence of a gallop rhythm in the context of heart failure as unfavorable.

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