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 summation gallop is the overlap of S3 and S4 as the patients heart rate reaches 110 bpm. This is due to the fact that only diastolic time is influenced by rate changes. It would be difficult to diagnose a summation gallop without seeing the progression from a quadruple gallop whos rate gradually increased. The clinical implacations are the same for the quadruple gallop.
Once you have the summation gallop mastered, go on to the next case.
Updated: September 24, 1997