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The S3 Gallop

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Learning Cardiac Auscultation

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Abstract

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.

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Abbreviations

ACC/AHA:

American College of Cardiology/American Heart Association

ACE:

Angiotensin-converting enzyme

AV valves:

Atrioventricular valves

BMI:

Body mass index

CHF:

Congestive heart failure

EDV:

End-diastolic volume

EF:

Ejection fraction

HF:

Heart failure

LV:

Left ventricular

LVEDP:

Left ventricular end diastolic pressure

LVEF:

Left ventricular ejection fraction

LVH:

Left ventricular hypertrophy

NSAID:

Non-steroidal anti-inflammatory drug

PMI:

Point of maximum impulse

PW Doppler:

Pulsed and continuous wave Doppler

S1:

First heart sound

S2:

Second heart sound

S3:

Third heart sound

S4:

Fourth heart sound

SOB:

Shortness of breath

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Author information

Authors and Affiliations

  1. Georgetown University Hospital, Georgetown University School of Medicine, Washington, DC, USA

    Cara Sweeney BS, MD & Blake Choplin BA, MD

Authors
  1. Cara Sweeney BS, MD
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  2. Blake Choplin BA, MD
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Corresponding author

Correspondence to Cara Sweeney BS, MD .

Editor information

Editors and Affiliations

  1. Medstar Georgetown University Hospital, Washington, District of Columbia, USA

    Allen J. Taylor

1 Electronic Supplementary Material

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)

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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Sweeney, C., Choplin, B. (2015). The S3 Gallop. In: Taylor, A. (eds) Learning Cardiac Auscultation. Springer, London. https://doi.org/10.1007/978-1-4471-6738-9_18

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  • DOI: https://doi.org/10.1007/978-1-4471-6738-9_18

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-6737-2

  • Online ISBN: 978-1-4471-6738-9

  • eBook Packages: MedicineMedicine (R0)

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