A summation gallop is the sound heard when the following heart sounds are present
a. S1, S2, S3 c. S1, S2, S3–4.
b. S1, S2, S4 d. opening snap, S1, S2, S3, S4.
C
When both the pathologic S3 and S4 are present, quadruple rhythm is heard. Often, in cases of cardiac stress, one response is tachycardia. During rapid rates, the diastolic filling time shortens and the S3 and S4 move closer together. They sound superimposed in mid-diastole, and you hear one loud, prolonged, summated sound, often louder than either S1 or S2 . This is called a summation gallop which is represented as S1, S2, S3–4.
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