Third heart sound - Wikipedia

The third heart sound or S3 is a rare extra heart sound that occurs soon after the normal two "lub-dub" heart sounds S3 is associated with heart failure. Thirdheartsound FromWikipedia,thefreeencyclopedia Jumptonavigation Jumptosearch MedicalconditionThirdheartsoundOthernamesVentriculargallop,protodiastolicgallopDiagramoftheheart.SpecialtyCardiology ThethirdheartsoundorS3isarareextraheartsoundthatoccurssoonafterthenormaltwo"lub-dub"heartsounds(S1andS2).S3isassociatedwithheartfailure. Contents 1Physiology 2Causes 3Associations 3.1Rapidventricularfilling 3.2Poorleftventricularfunction 4Treatment 5Seealso 6References 7Externallinks Physiology[edit] Itoccursatthebeginningofthemiddlethirdofdiastole,approximately0.12to0.18secondsafterS2.[1]Thisproducesarhythmclassicallycomparedtothecadenceoftheword"Kentucky"withthefinalsyllable("-CKY[2]")[3]representingS3.Onemayalsousethephrase"Slosh’-ing-IN"tohelpwiththecadence(SloshS1,-ingS2,-inS3),aswellasthepathologyoftheS3sound,[4]oranyothernumberoflocalvariants. S3maybenormalinpeopleunder40yearsofageandsometrainedathletesbutshoulddisappearbeforemiddleage.Re-emergenceofthissoundlateinlifeisabnormal[5]andmayindicateseriousproblemslikeheartfailure.ThesoundofS3islowerinpitchthanthenormalsounds,usuallyfaint,andbestheardwiththebellofthestethoscope.[citationneeded] Ithasalsobeentermedaventriculargalloporaprotodiastolicgallopbecauseofitsplaceinearlydiastole.Itisatypeofgalloprhythmbyvirtueofhavinganextrasound;theothergalloprhythmiscalledS4.Thetwoarequitedifferent,buttheymaysometimesoccurtogetherformingaquadruplegallop.Iftheheartrateisalsoveryfast(tachycardia),itcanbecomedifficulttodistinguishbetweenS3andS4thusproducingasinglesoundcalledasummationgallop.S3isadull,low-pitchedsoundbestheardwiththebellplacedoverthecardiacapexwiththepatientlyingintheleftlateraldecubitusposition.Thisheartsoundwhenpresentinachildoryoungadultimpliesthepresenceofasuppleventriclethatcanundergorapidfilling.Conversely,whenheardinamiddle-agedorolderadult,anS3isoftenasignofdisease,indicatingincreasedventricularfillingduetocongestiveheartfailureorseveremitralortricuspidregurgitation.[6] Causes[edit] S3isthoughttobecausedbytheoscillationofbloodbackandforthbetweenthewallsoftheventriclesinitiatedbytheinflowofbloodfromtheatria.Thereasonthethirdheartsounddoesnotoccuruntilthemiddlethirdofdiastoleisprobablythat,duringtheearlypartofdiastole,theventriclesarenotfilledsufficientlytocreateenoughtensionforreverberation.Itmayalsobearesultoftensingofthechordaetendineaeduringrapidfillingandexpansionoftheventricle.[citationneeded] Associations[edit] Itisassociatedwithheartfailure,[7]causedbyconditionswhichhave: Rapidventricularfilling[edit] Mitralregurgitation-thisiswhenoneofthemitralvalveleafletsthatusuallystopbloodflowingfromtheleftventricletotheleftatriumfails,allowingbloodintotheatriaduringsystole.Thismeansthattheleftatriumwillbeoverfilled,leadingtorapidventricularfillingwhenthemitralvalveopens.[8] Elevatedleftatrialandleftventricularfillingpressures,usuallyaresultofastiffenedanddilatedleftventricle Ventricularseptaldefect-thisisaholeinthewallbetweenthetwoventricles,whichallowsrapidfillingfromtheotherventricle. Poorleftventricularfunction[edit] Post-MI-thedeathoftissueintheventricularwallduetolossofbloodsupplycauseswallareaswhichdonotmoveaswellasnormal(hypokinesia),ornotatall(akinesia),meaningtheyrelaxmoreslowly,sotheventricularfillingisrelativelytoorapid. Dilatedcardiomyopathy-theventricularwallsareabnormalforavarietyofreasons,andbecomethinandstiffsodonotrelaxwell. S3canalsobeduetotricuspidregurgitation,andcouldindicatehypertensiveheartdisease.[citationneeded] Inconditionsaffectingthepericardiumordiseasesthatprimarilyaffecttheheartmuscle(restrictivecardiomyopathies)asimilarsoundcanbeheard,butisusuallymorehigh-pitchedandiscalleda'pericardialknock'.TheS3canalsobeconfusedwithawidelysplitS2,oramitralopeningsnap,butthesesoundsaretypicallyofmuchhigherpitchandoccurclosertotheonsetofS2.[citationneeded] Treatment[edit] Theconditionitselfdoesnotneedtobetreated,butrathertheunderlyingcauserequirescorrection.Dependingontheetiologythegalloprhythmmayresolvespontaneously.[citationneeded] Seealso[edit] AlexanderGeorgeGibson ArthurD.Hirschfelder References[edit] ^"Techniques-HeartSounds&MurmursExam-PhysicalDiagnosisSkills-UniversityofWashingtonSchoolofMedicine".Retrieved2009-03-06. ^CoreCurriculumforCriticalCareNursing ^"Techniques-HeartSounds&MurmursExam-PhysicalDiagnosisSkills-UniversityofWashingtonSchoolofMedicine". ^Einthoven,W.(1907)."TheThirdHeartSound".TheAuscultationAssistant-RubsandGallops.10:93.Bibcode:1907KNAB...10...93E. ^"THEPHONOCARDIOGRAPHY".Retrieved2009-03-06. ^PathophysiologyofHeartDisease.LeonardS.Lilly.LeaandFebiger1993 ^KumarD,CarvalhoP,AntunesM,et al.(2007)."Thirdheartsounddetectionusingwavelettransform-simplicityfilter".200729thAnnualInternationalConferenceoftheIEEEEngineeringinMedicineandBiologySociety.ConfProcIEEEEngMedBiolSoc.Vol. 2007.pp. 1277–81.doi:10.1109/IEMBS.2007.4352530.ISBN 978-1-4244-0787-3.PMID 18002196.S2CID 21020807. ^Lilly,Leonardetal.PathophysiologyofHeartDisease,FourthEdition,page37. Externallinks[edit] ClassificationDICD-9-CM:427.9,785.3DiseasesDB:13037 KUOPT,SCHNABELTG,BLAKEMOREWS,WHEREATAF(1957)."DiastolicGallopSounds,theMechanismofProduction".J.Clin.Invest.36(7):1035–42.doi:10.1172/JCI103499.PMC 1072690.PMID 13449156. vteSignsandsymptomsrelatingtothecirculatorysystemChestpain Referredpain Angina Levine'ssign Auscultation Heartsounds SplitS2 S3 S4 Galloprhythm Heartmurmur Systolic Functionalmurmur Still'smurmur Diastolic Pulmonaryinsufficiency GrahamSteellmurmur Continuous CareyCoombsmurmur Mitralinsufficiency Presystolicmurmur Pericardialfrictionrub Heartclick Bruit carotid Pulse Tachycardia Bradycardia Pulsusparadoxus doubled Pulsusbisferiens Pulsusbigeminus Pulsusalternans Other Palpitations Apexbeat Cœurensabot Jugularvenouspressure CannonAwaves Hyperaemia Shock Cardiogenic Obstructive Hypovolemic Distributive SeefurtherTemplate:Shock CardiovasculardiseaseAorticinsufficiency Collapsingpulse DeMusset'ssign Duroziez'ssign Müller'ssign AustinFlintmurmur Mayne'ssign Otherendocardium endocarditis:Roth'sspot Janewaylesion/Osler'snode Bracht–Wachterbodies Pericardium Cardiactamponade/Pericardialeffusion:Beck'striad Ewart'ssign Other rheumaticfever: Anitschkowcell Aschoffbody EKG Jwave Gallavardinphenomenon VasculardiseaseArterial aorticaneurysm Cardarelli'ssign Oliver'ssign pulmonaryembolism Rightheartstrain radialarterysufficiency Allen'stest pseudohypertension thrombus LinesofZahn Adson'ssign arteriovenousfistula Nicoladoni–Branhamsign Venous Friedreich'ssign Caputmedusae Kussmaul'ssign Trendelenburgtest superiorvenacavasyndrome Pemberton'ssign Retrievedfrom"https://en.wikipedia.org/w/index.php?title=Third_heart_sound&oldid=1057065215" Categories:CardiologyHiddencategories:ArticleswithshortdescriptionShortdescriptionisdifferentfromWikidataAllarticleswithunsourcedstatementsArticleswithunsourcedstatementsfromApril2021 Navigationmenu Personaltools NotloggedinTalkContributionsCreateaccountLogin Namespaces ArticleTalk English Views ReadEditViewhistory More Search Navigation MainpageContentsCurrenteventsRandomarticleAboutWikipediaContactusDonate Contribute HelpLearntoeditCommunityportalRecentchangesUploadfile Tools WhatlinkshereRelatedchangesUploadfileSpecialpagesPermanentlinkPageinformationCitethispageWikidataitem Print/export DownloadasPDFPrintableversion Languages العربية中文 Editlinks