Gallop
Formal Definition
An abnormal extra heart sound (S3 or S4) that creates a three-beat cardiac rhythm resembling a horse gallop; S3 is heard in early diastole and suggests volume overload or systolic heart failure; S4 is heard in late diastole and suggests a stiff, non-compliant ventricle.
How It's Used on the Ward
"S3 gallop" or "has a gallop" — a high-yield bedside finding pointing toward heart failure or fluid overload.
Example
""On exam: JVP elevated to the angle of the jaw, bibasilar crackles, 2+ pitting edema to the knees, and an S3 gallop. BNP is 4,200. Starting diuresis.""
Clinical Context
S3 ("Ken-tuck-y") = pathological in adults over 40, suggests systolic heart failure, volume overload, or MR/TR. S4 ("Ten-nes-see") = late diastolic, suggests diastolic dysfunction, hypertensive heart disease, or active ischemia. Both are low-pitched and best heard with the bell of the stethoscope at the apex with the patient in left lateral decubitus. Often missed — requires a quiet room and deliberate technique.