Atrial gallop in coronary heart disease without overt infarction

The third heart sound for diagnosis of acute heart failure

Dyspnea is a common presenting complaint in the emergency department (ED). Rapid identification of heart failure as the etiology leads to early implementation of targeted therapies. Although having only intermediate sensitivity, the S3 is a highly specific finding among older adults with heart failure. Identification of an S3 by routine auscultation can be problematic given the chaotic and noisy ED environment, patient comorbid conditions, and intolerance of ideal positioning for auscultation. Technologies using computerized analysis of digitally recorded heart tones have recently been developed to aid the clinician with bedside detection of abnormal heart sounds. Data using these technologies and their applications in the ED are reviewed as well as implications for future use and research.

Prevalence of the third and fourth heart sound in asymptomatic adults

The prevalence of abnormal diastolic heart sounds in asymptomatic adults has been the subject of great debate. The authors determined the prevalence of an electronically detected S3 and S4 in 1329 asymptomatic adults between the ages of 18 and 94. The authors also investigated the relationship between abnormal diastolic heart sounds, age, and electrocardiography. The overall prevalence of S3 was 10.0% (95% confidence interval [CI], 8.1%-12.2%), S4 was 15.6% (95% CI, 13.2%-18.2%), and both S3 and S4 were 3.5% (95% CI, 2.4%-5.0%). Using multinomial logistic regression, increasing age was found to decrease the odds of an S3 being heard (odds ratio, 0.96; 95% CI, 0.95-0.96) and increase the odds of an S4 being heard (odds ratio, 1.04; 95% CI, 1.03-1.05). We conclude that the prevalence of an S3 is increased earlier in life, that an S4 is less common than previous studies suggest, and that its detection, even in the elderly, should not be ignored.