Examine the illustration and play the WAV file multiple times. It is more important to learn the cadence (pattern / timing) than the quality of the sounds at this point.
Remember and review the cardiac events as you listen. The quadruple gallop is produced by S4, S1, S2, and S3. Because S3 and S4 are low in intensity, low pitch sounds this is best heard with the bell of your stethoscope pressed lightly on the apex area of the heart. The quadruple gallop sounds like a galloping horse. It suggests that you are dealing with a congestive heart failure and often a very sick patient. the cadence sound like "I can't Keep up" which is representive of the heart's situation. Remember that S3 and S4 are very faint so turn down the volume until you can just hear the S3 & S4.
Once you have the quadruple gallop mastered, go on to the next case.
Updated: September 23, 1997