GALLOP RHYTHM — three-membered (seldom four-membered) cordial rhythm, emergence to-rogo it is caused by strengthening not heard normal (but registered fonokardiografichesk) fiziol, tones over heart and the vessels departing from it. On acoustic signs reminds footfall of the galloping horse. During each cardial cycle it is listened, except usual two tones, additional tone (or two additional tones). It is necessary to distinguish from splitting or bifurcation of the first and second cardiac sounds. Additional tone at is auskultativno perceived as independent, but not as a component of the doubled first or second cardiac sound.
The term «gallop a rhythm» (bruit de galop) is for the first time applied by Zh. Buyo in 1847, the classical description and a wedge, assessment numbers in 1875 are given to P. K. E. Pota, then it was studied by L. Traube, V.P. Obraztsov, N. D. Strazhesko, M. M. Gubergrits, etc. The phonocardiographic picture was described by L. I. Fogelson, Volfert and Margolis (Ch. Wolferth, A. Margolies), P. Duchosal, A. Luisada, etc. At the end of 19 and at the beginning of 20 century clinical physicians carried to Not all numerous rhythms, and only those from them, to-rye are combined with tachycardia. Moreover, H. Huchard considered that tachycardia in a combination to weakness of a myocardium possesses a leading role in emergence. According to H. Huchard, about it is possible to speak only when the additional tone which was not listened at normal rate of cordial reductions becomes heard with development of tachycardia. A number of clinical physicians also allocates as the special type of a three-membered rhythm developing at insufficiency of a myocardium. However others [A. L. Myasnikov, G. I. Kassirsky, Fridberg (S. K. of Friedberg)] call all polynomial rhythms revealed auskultativno, irrespective of heart rate, a cantering rhythm.
It is found at auscultation of heart, sometimes at a palpation of cordial area and has certain phonocardiographic signs (see below). The training of hearing Is necessary for auskultativny identification. Best of all it is heard at direct auscultation of heart according to V. P. Obraztsov (see. Heart , methods of a research). At auscultation a stethoscope and a phonendoscope, as well as at a palpation, comes to light only sharply expressed. It is easier to find in position of the patient on the left side, after movements. Additional tone usually deaf, sometimes hardly distinguishable at careful direct auscultation as acoustic or only a tactile phenomenon (insignificant concussion of precardiac area). Most often it is listened in the field of a top of heart, in the fifth point (is more often at weakness of a left ventricle) and at a xiphoidal shoot (at weakness of a right ventricle).
Distinguish two types: diastolic and systolic. A sign of insufficiency of a myocardium is diastolic type. Depending on finding of additional tone at the beginning, the middle or the end of a diastole allocate proto - mesodiastolic and presystolic. Protodiastolic call also ventricular, presystolic — atrial. However emergence of additional tone at presystolic Is connected with changes not so much in auricles how many in ventricles therefore it is more correct to call it atrioventricular. Mesodiastolic can be ventricular and atrioventricular.
Since P. K. E. Potena there are two theories of an origin protodiastolic. According to the first theory, additional tone arises at considerable decrease in a tone of a myocardium owing to what passive filling of ventricles in a protodiastole is followed by the bystry stretching of their walls which is shown palpatorny and sound phenomena. According to the second theory, additional tone is caused by vibration of shutters of atrioventricular valves during filling of ventricles. The first theory which received confirmation at simultaneous registration of FKG, the phlebogram, ECG, elektrokimogramma, changes of pressure in cardial cavities, etc. has bigger distribution. Additional tone at ventricular is considered as the strengthened fiziol, third tone which is often listened at children and teenagers. On FKG the third tone is considered pathological if it is registered at persons 40 years are more senior, has amplitude more than 2/3 amplitudes of the first tone and frequency over 30 Hz. At considerable weakening of a myocardium ekstraton it can be found not only on low - and mid-frequency registers, but also on high-frequency. Duration its 0,04 — 0,1 sec., and the interval separating from the second tone, 0,12 — 0,18 sec.
Presystolic it is also connected with decrease in a tone of a myocardium and ventricles, vibration of their walls, but only during active filling (auricular systole). In this regard in formation presystolic also the sound vibrations arising at reduction of auricles, i.e. fiziol matter. fourth cardiac sound. Participation of an atrial component increases at a hypertrophy of auricles and lengthening of atrioventricular conductivity. On FKG the fourth tone is regarded as pathological if there is at least one of the following signs: advanced age of the patient, preservation of extra-tone at vertical position of a body, frequency is higher than 70 Hz. Considerable weakening of a tone of a muscle of heart is followed by increase in frequency of the fourth tone. Duration its 0,05 — 0,12 sec., the interval separating from top of a tooth of P on an ECG — 0,07 — 0,18 sec. In nek-ry cases neither these auscultations, nor data of a phonocardiography allow to carry to a protodiastolic or presystolic form. Perhaps, in these cases patholologically the strengthened third cardiac sound merges against the background of tachycardia with the fourth tone. A similar form a number of authors calls mesodiastolic.
Systolic it is not connected with insufficiency of a myocardium. Additional tone arises at the beginning of a systole owing to stretching patholologically of the changed large vessels: aortas at its atherosclerosis, expansion, a stenosis of an isthmus and pulmonary trunk at its expansion, hypertensia of a small circle, Eyzenmenger's syndrome (see Atherosclerosis, Hypertensia of a small circle of blood circulation., Coarctation of an aorta). Additional aortal tone is better listened in the II mezhreberye to the right of edge of a breast and additional tone of a pulmonary artery — is well carried out to the II mezhreberye to the left of edge of a breast to a top. On FKG well is registered on mid-frequency the first, the second and high-frequency ranges. Will be spaced from the beginning of the first tone on 0,09 — 0,1 sec.
Not all clinical physicians agree that «systolic tone of exile» should be referred to though P. Poten allocated a systolic cantering rhythm. A. L. Myasnikov, M. V. Chernorutsky, etc. agree with P. Poten's opinion.
Diastolic — an important sign of weakness of a myocardium of ventricles — «shout of heart about the help» (V.P. Obraztsov). Most often comes to light at myocardial infarction (see), to aneurism of heart (see), diffusion myocardites (see), nephrites, idiopathic hypertensia (see), and also at the dekompensirovanny acquired and inborn heart diseases (see. Heart diseases inborn , acquired ), pulmonary heart (see), myocardioscleroses (see. Cardiosclerosis ). It can be observed at a hyperthyroidism (see. Thyrotoxicosis ), anemias (see). At aneurism of heart additional tone sometimes happens loud. Emergence in the patient with stenocardia often is a sign of development of a myocardial infarction.
Especially protodiastolic, has serious predictive value. Its emergence is especially adverse at acute diseases (acute nephrite, a myocardial infarction, myocarditis). With recovery disappears.
It is necessary to differentiate with bifurcation of the first and second tones, with an opening snap of the valve at mitral and tricuspid stenoses (louder tones adjoining the first or second tone), with a bisystole (double reduction of ventricles), bifurcation of the first tone, with a protodiastolic ekstraton — a pericardium tone — the short click which is observed at an union of a pericardium. The pericardium tone can be listened also in a systole. Unlike systolic, it is closer to the second tone or is in a mesosystole. The bigeminal pulse with hemodynamically inefficient extrasystoles (two tones of normal reduction of heart, one tone of the extrasystole which is not opening valves of an aorta and pulmonary artery) imitates. Additional tone in this case loud. Flint's noise, a pericardial rub can be taken for additional tone indistinctly listened presystolic noise at a mitral stenosis. In difficult cases carrying out tool methods of a research specifies the diagnosis — electrocardiography (see), phonocardiography (see), etc.
Bibliography: Gubergrits M. M. Chosen works, page 163, Kiev, 1959; Lang G. F. A research of bodies of blood circulation, in book: Bases a wedge, diagnoses, under the editorship of A. M. Levin and D. D. Pletnev, page 191, M. — L., 1923; Mikhnev A. L. Sledzevskaya I. K. and Yanovsky G. V. Clinical phonocardiography, Kiev, 1970; Nesterov V. S. Clinic of heart troubles and vessels, Kiev, 1971; V. P Is model. Chosen works, page 63, etc., Kiev, 1950; P about t e N To. Clinical lectures, the lane with fr., SPb., 1897; Strazhesko N. D. Chosen works, t. 1, page. And, etc., Kiev, 1955; F about-gelson L. I. Heart trouble and vessels, page 763, M., 1951; Holldak K. and Wolf. The atlas and the guide п© to a phonocardiography and adjacent mekhanokar-diografichesky methods of a research, the lane with it., page 71, etc., M., 1964.
A. I. Gritsyuk.