Mason Blake
The third heart sound, or S3, is a rare extra heart sound that occurs after the normal two lub-dub heart sounds. It is associated with heart failure, although it may be normal in children, young adults, and athletes. S3 is caused by blood rushing into a specific chamber, resulting in vibrations within the myocardial wall and the atrioventricular valve. While it is typically harmless in young people and athletes, it can indicate heart problems in older adults. Infections can cause heart murmurs and valve problems, which may contribute to abnormal heart sounds.
| Characteristics | Values |
|---|---|
| What is the third heart sound? | A rare extra heart sound that occurs soon after the normal two "lub-dub" heart sounds (S1 and S2). |
| What does it indicate? | Heart failure, especially in older adults. It could be harmless in children, young adults, athletes, and pregnant women. |
| What does it sound like? | A dull, low-pitched sound. |
| What causes it? | Vibrations within the myocardial wall and the atrioventricular valve, caused by blood rushing into a ventricle. |
| How is it detected? | Using a stethoscope, the sound is best heard with the bell placed over the cardiac apex with the patient lying in the left lateral decubitus position. |
| How common is it? | It is often the most difficult heart sound to hear due to its very low intensity and frequency. |
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What You'll Learn
- The third heart sound (S3) is a low-frequency sound occurring during diastole
- S3 is associated with heart failure
- S3 can be normal in children, young adults, and trained athletes
- S3 is caused by vibrations within the myocardial wall and the atrioventricular valve
- S3 is the result of rapid ventricular filling
The third heart sound (S3) is a low-frequency sound occurring during diastole
The third heart sound, or S3, is a rare extra heart sound that occurs after the normal two "lub-dub" heart sounds (S1 and S2). It is a low-frequency sound that occurs during diastole, specifically during the rapid filling of the ventricles. It is caused by vibrations within the myocardial wall and the atrioventricular valve. The amplitude of S3 increases with an increased ventricular filling rate.
The presence of an S3 sound is associated with heart failure and is more frequently heard with systolic heart failure compared to diastolic heart failure. It is typically considered abnormal in middle-aged and older adults and may indicate increased ventricular filling due to congestive heart failure or severe mitral or tricuspid regurgitation. However, it can be considered normal in children, young adults, athletes, and during pregnancy.
The sound of S3 is usually faint and low-pitched, and it can be challenging to hear due to its low intensity. It is best detected using a stethoscope with the bell placed over the cardiac apex, with the patient lying in the left lateral decubitus position. The intensity of the sound can be influenced by factors such as patient position, atrial pressure, blood volume, and ventricular cavity size.
The third heart sound is an important indicator of potential heart failure or ventricular dysfunction, especially when it reappears in later life. However, it is not always present in all cases of ventricular dysfunction, and its absence does not exclude the possibility of ventricular issues. Treatment for heart failure typically involves a combination of lifestyle changes and medication.
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S3 is associated with heart failure
The third heart sound or S3 is a rare extra heart sound that occurs soon after the normal two "lub-dub" heart sounds (S1 and S2). S3 is classically associated with heart failure. It is a low-pitched sound, usually faint, and best heard with the bell of the stethoscope. S3 may be normal in people under 40 years of age and some trained athletes but should disappear before middle age.
The presence of an S3 is an indicator of ventricular dysfunction. It occurs when blood strikes the wall of a stretched or enlarged ventricle (one of the heart's lower chambers). This can be caused by dilated cardiomyopathy (DCM), which is one of the most common causes of heart failure. DCM occurs when the ventricles distend and enlarge, preventing the heart from contracting and pumping blood properly. Other causes of heart failure and an S3 include coronary artery disease, heart valve disease, and chronically high blood pressure.
In addition to attending appointments, individuals living with heart failure will need to monitor their fluid and salt intake and keep track of their weight at home. They should also seek medical attention if they are experiencing possible symptoms or signs of heart failure, such as breathlessness, fatigue, a persistent cough, or swelling in the ankles or stomach.
It is important to note that the absence of an S3 does not necessarily indicate the absence of ventricular dysfunction or volume overload. This is because the intensity of the third heart sound can be influenced by various factors, such as chest size, obesity, or lung disease, and may not always be heard despite severe hemodynamic impairment.
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S3 can be normal in children, young adults, and trained athletes
The third heart sound, or S3, is a rare extra heart sound that occurs soon after the normal two "lub-dub" heart sounds (S1 and S2). S3 is associated with heart failure, typically indicating that one of the ventricles is stretched or enlarged. However, it is important to note that S3 can be normal in children, young adults, and trained athletes under 40 years of age.
In children and young adults, the presence of S3 implies the existence of a supple ventricle capable of rapid filling. This is because S3 is caused by the undulation of blood between the ventricle walls as blood flows in from the atria. The ventricles need to be sufficiently filled for this undulation to create enough tension for reverberation, which is why S3 typically occurs in the middle third of diastole.
While S3 can be harmless in certain cases, it may also indicate heart problems such as systolic or diastolic heart failure, valve issues, or hypertensive heart disease. In individuals with systolic heart failure, the ventricles struggle to contract and pump blood effectively during a heartbeat. Diastolic heart failure, on the other hand, is characterised by ventricles that cannot relax and fill with blood adequately between heartbeats. S3 is more frequently associated with systolic heart failure.
When detected in children, young adults, or trained athletes, S3 is typically assessed for its significance by considering the presence or absence of significant heart disease. If S3 re-emerges in middle age or later, it may be abnormal and indicative of serious problems like heart failure. Therefore, while S3 can be normal in certain populations, it is always advisable to consult a medical professional for a thorough evaluation and appropriate guidance.
In summary, while S3 can be considered normal in children, young adults, and trained athletes, it is not always harmless. A comprehensive medical evaluation is necessary to determine the underlying cause and rule out any potential heart-related issues.
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S3 is caused by vibrations within the myocardial wall and the atrioventricular valve
The third heart sound, or S3, is a rare extra heart sound that occurs soon after the normal two "lub-dub" heart sounds (S1 and S2). S3 is associated with heart failure. It is a low-frequency sound occurring during diastole, attributed to the rapid filling of the ventricles. S3 is caused by vibrations within the myocardial wall and the atrioventricular valve. It can indicate left or right ventricular origin depending on its location when auscultated.
The third heart sound is the result of early diastolic left ventricular (LV) filling and abrupt deceleration of the atrioventricular blood flow. The higher the transmitral inflow rate and the steeper the rapid filling, the greater the deceleration of the LV inflow, and the more likely a third heart sound will be generated. The amplitude of S3 increases with an increased ventricular filling rate. When heard at the apex, S3 is considered left ventricular in origin, and when heard at the lower left sternal border, S3 is likely to be right ventricular in origin.
S3 is thought to be caused by the undulation of blood back and forth between the walls of the ventricles initiated by the inflow of blood from the atria. This is due to the tensing of the chordae tendineae during rapid filling and expansion of the ventricle. The mitral valve annulus diameter is one of the more important factors in producing the S3 sound.
S3 may be normal in people under 40 years of age and some trained athletes but should disappear before middle age. Re-emergence of this sound late in life is abnormal and may indicate serious problems such as heart failure. The sound of S3 is lower in pitch than the normal sounds, usually faint, and best heard with the bell of the stethoscope.
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S3 is the result of rapid ventricular filling
The third heart sound or S3 is a rare extra heart sound that occurs soon after the normal two "lub-dub" heart sounds (S1 and S2). S3 is associated with heart failure. It occurs at the beginning of the middle third of diastole, approximately 0.12 to 0.18 seconds after S2. This produces a rhythm that can be compared to the cadence of the word "Kentucky", with the final syllable ("-CKY") representing S3.
The presence of an S3 heart sound is commonly detected in older patients with heart failure. However, it may also be present in healthy individuals, including children, pregnant people, and well-trained athletes. In such cases, the third heart sound is usually harmless and not a sign of heart failure.
The S3 heart sound occurs as the mitral valve opens and allows blood to fill the left ventricle passively. The sound happens due to blood striking the left ventricle during early diastole. Early diastole refers to when the ventricle starts to expand and the pressure within it is low. S3 may be an indicator of systolic heart failure, diastolic heart failure, or dilated cardiomyopathy.
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Frequently asked questions
The third heart sound (S3) is a rare extra heart sound that occurs after the normal two "lub-dub" heart sounds (S1 and S2). It is associated with heart failure.
The third heart sound indicates that one of the ventricles, usually the left ventricle, is stretched or enlarged. It is a typical early finding in heart failure.
The third heart sound is caused by vibrations within the myocardial wall and the atrioventricular valve during the rapid filling of the ventricles. It can indicate left or right ventricular origin depending on its location when auscultated.
In adults, heart murmurs or abnormal heart sounds are usually the result of problems with heart valves, which may be caused by an infection such as infective endocarditis or mitral valve prolapse. However, it is unclear if an infection can directly cause the third heart sound (S3).
