The S3 Gallop

  • Cara Sweeney
  • Blake Choplin


The third heart sound (S3) most commonly appears in individuals under the age of forty. A pathologic presentation occurs more often in older individuals in volume-overloaded states, such as heart failure. This diastolic gallop is produced by rapid deceleration of transmitral blood flow as it strikes a noncompliant left ventricle. The change in velocity causes reverberations that produce the sound. An S3 is best detected in a quiet room with the bell of the stethoscope placed at the apex while the patient is in the left lateral decubitus position. A positive finding may have several implications depending on the clinical context. Most often an S3 is a sign of reduced left ventricular ejection fraction and therefore left ventricular dysfunction. In aortic stenosis, tricuspid regurgitation and mitral regurgitation the presence of a third heart sound is a sign of severe disease. Similarly, the prognosis for a heart failure patient with an S3 is worse. Treatment is aimed at alleviating the underlying disease process through medical or surgical intervention.


S3 Gallop Third Heart Sound Left Ventricular Dysfunction Heart Failure Diastolic Sounds 



American College of Cardiology/American Heart Association


Angiotensin-converting enzyme

AV valves

Atrioventricular valves


Body mass index


Congestive heart failure


End-diastolic volume


Ejection fraction


Heart failure


Left ventricular


Left ventricular end diastolic pressure


Left ventricular ejection fraction


Left ventricular hypertrophy


Non-steroidal anti-inflammatory drug


Point of maximum impulse

PW Doppler

Pulsed and continuous wave Doppler


First heart sound


Second heart sound


Third heart sound


Fourth heart sound


Shortness of breath

Supplementary material

310603_1_En_18_MOESM1_ESM.mp4 (1.1 mb)
Video 18.1 S3 murmur. Also soft Still’s murmur; Echo is WNL (Provided by Robin Winkler Doroshow, MD, Medstar Georgetown University Hospital, Washington, DC) (MP4 1150 kb)
310603_1_En_18_MOESM2_ESM.mp4 (2.9 mb)
Video 18.2 Several patients with an S3 gallop, including a 60 year old woman with ventricular gallop, as described by Dr. W. Proctor Harvey (File 082 from Clinical Cardiology by W. Proctor Harvey, MD, MACC, Jules Bedynek, MD, and David Canfield and published by Laennec Publishing Inc., Fairfield, NJ. Used with permission and copyrighted by Laennec Publishing, Inc. All rights reserved) (MP4 2927 kb)


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Copyright information

© Springer-Verlag London 2015

Authors and Affiliations

  1. 1.Georgetown University Hospital, Georgetown University School of MedicineWashingtonUSA

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