Clinical aspects of gallop rhythm with particular reference to diastolic gallops.

G ALIO)1P rhythmi rel)esellts one of the minost important but still veryconfused aspeets of elinical auscultation of the heart. Most gallop rhythms are uinre(ogniized or misillterprete(l. This is unfortunate because a gallop, depending on the type, often represents the earliest elinieal evideiiee of (ongI.tive heart failure. After anialyzing the varloiis (lassifieatiolns of gallops1-21 we hve used( the followincg clinical elassificationi which We eoisider physiologic, praetical, ald simplle. (allops are first divided illtO systolic allld liastolic gallops (fig. 1). The systolic gallop (or click) is aii extra sound occurring in systole, generally lb-st hteard at the apex and usually represe(ntintg a b)eniigni findinig.7' . 15 Its exact etiologyN, is 0lot knUown, but in a number of cases appears to l)e extracardiac in origin. A few of the patients with this benign systolic sound have a )ast history of severe pneumonia, pleurisy, or l(,ss (c011111loiolv emlpyea. 011( could speculate ill suell cases as to the possibility of adhUsionls (.olltril)utillgf to this sound. The majority, however, have a completely negative hlistory. In addition to this benigni type of systolic sound there may be systolic soundds llear(l in conjunction with organic heart disease. For example, in aortic inisuifficien(cy a systolic sound may be heard at the apex, base, anid leripheral arteries which has beeni ternmed a systolic ejection sound, "'pistol shot,'' systolic click, or gallop.5 6. 1:1. 14 W\hen this is present (e.g., with aortic insufticiency) oiie usually has no difficulty iii deternuiiing the presence of orgralic heart (lisease. In aortie insuffiieiicy of a severe degree the first