Triple rhythm may be said to occur whenever three sounds can be heard instead of the normal two. It is important to recognize that there are physiological and pathological forms of triple rhythm and to differentiate between them, otherwise serious errors in diagnosis may be made and unwarranted fears engendered. It is far better to ignore all such added sounds than to misinterpret them. Nevertheless they are a common source of confusion in practice. It is not the mechanism (which is often obscure or debatable) but the significance of the sounds which matters most. It the doctor has any doubt in his mind about the nature of additional heart should he should refer the patient to a cardiologist. In the first, triple rhythm should be distinguished from splitting of the first or second heart sounds and from short diastolic murmurs.
An extra heart sound, in diastole, may be physiological especially in children or young persons and in pregnancy, or pathological in failure of the left or right ventricle. The differentiation between a physiological and pathological triple rhythm cannot be made by auscultation alone, but only by the presence presence of absence of other evidence of heart disease, i.e. by consideration of the symptoms and signs and by the detection of some etiological factor which might be responsible for cardiac failure One should always beware of drawing conclusions from an isolated sign. In established heart disease triple rhythm is usually of serious prognostic significance.
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