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third heart sound (S3), S3 gallop

Etiology: - normal in children & in pregnant women [3] - after the age of 30-35, an S3 indicates a) left ventricular failure b) volume overload on the left ventricle 1] aortic regurgitation 2] mitral regurgitation 3] cardiomyopathy c) pulmonary hypertension* * S3 gallop best heard at the left sternal border with the patient supine * right-sided gallops best heard with the patient supine * left-sided gallops best heard with patient in left lateral decubitus position Pathology: - probably caused by tensing of the chordae tendinae as blood distends the left ventricle during diastole Clinical manifestations: - low-pitched sound following S2, heard best with the bell of the stethoscope at the apex of the heart Management: - avoid beta-blockers & calcium channel blockers in patients with decompensated heart failure

General

abnormal heart sound

References

  1. Harrison's Principles of Internal Medicine, 13th ed. Companion Handbook, Isselbacher et al (eds), McGraw-Hill Inc. NY, 1995, pg 327
  2. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 38
  3. Medical Knowledge Self Assessment Program (MKSAP) 16 American College of Physicians, Philadelphia 2012