Chapter 31, Problem 1CAQ

Summary Introduction

To determine:

Mrs. M tells the nurse that the health care provider informed her that she has an S₃ gallop. She asks the nurse what this means. Provide an explanation for Mrs. M.

Case summary:

The nurse received morning report for Mrs. M, age 71, admitted to the hospital yesterday with fatigue, a cough, and dyspnea; she is diagnosed with chronic heart failure. She states that she had increasing difficulty with shortness of breath and swelling in her legs. Pedal pulses are +1 bilaterally. On auscultation the nurse hear bilateral crackers in the lung bases and an S₃ gallop when auscultating the heart. Respiratory rate is 18; heart rate is 84 and regular. The patient has an occasional non-productive cough. She is receiving 2L of oxygen by nasal cannula.

Explanation of Solution

Mrs. M had S3 gallop, the nurse provides explanation about gallop, which means an abnormal rhythm of the heart occurs on auscultation. Normal heart rhythm has an S1 and S2, it is referred as “lub –dub”. These sounds caused by closing the heart valves. Depending on the location of this sound a gallop rhythm is called as S₃ and S_4.  These gallop sounds usually occur in athletics and young people who have serious problems of heart failure.

The S₃ is a low-pitch, dull sound which is usually heard with stethoscope bell sound. The S₃ is caused by blood flow between the ventricle walls, which is initiated by the flow of blood from the atria. In young age, S₃ gallop can be cured spontaneously and it is not a disease (rapid filling due to bent ventricle). When it occurs in elderly people, then it gives a sign of disease (ventricular filling is increased due to heart failure).

Conclusion

The nurse provides a possible explanation about S₃ gallop to Mrs. M that it is an abnormal sound of the heart that occurs in young and older aged people.