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Introduction: The third heart sound (S3) is a relatively uncommon occurrence in individuals over the age of 40 and is typically associated with heart failure. It manifests as an additional heart sound following the familiar lub-dub sounds and is often linked to abnormal cardiac function. Clinically, the S3 heart sound is characterized by a displaced apical pulse (Shono et al., 2019). This third heart sound is a low-frequency, brief vibration that emerges at the end of diastole. It is commonly referred to as a ventricular gallop, diastolic gallop, or protodiastolic gallop, and was initially described by Jean-Baptiste Bouillaud in 1847 to depict the rhythm of the three heart sounds occurring in rapid succession.
Pathophysiology
The occurrence of the third heart sound (S3) is often associated with various medical conditions, including tachypnea, tachycardia, mitral regurgitation, dilated cardiomyopathy, post-myocardial infarction (MI), ventricular septal defects, and elevated left atrial and ventricular pressures. Its pathogenesis is closely linked to ventricular dysfunction. In the case of a myocardial infarction (MI), the heart muscle undergoes ischemia due to the blockage of coronary arteries, which can be caused by atherosclerotic plaques.
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These plaques act as sources of thrombi downstream, leading to myocardial necrosis within approximately 24 hours. In left-sided heart failure, the left ventricular wall becomes dilated due to increased resistance and reduced cardiac output. This dilation activates the renin-angiotensin system, exacerbating the condition by increasing systemic volume and causing volume overload on an already compromised heart (Latha, Sabanayagam & Aneesh, 2017).
Conclusion
The presence of the third heart sound (S3) serves as an indicator of cardiovascular pathology that demands immediate attention for patient management. When detected during physical examination or echocardiography, it necessitates thorough monitoring and appropriate intervention to improve patient outcomes.
References
Latha, R., Sabanayagam, A., & Aneesh, Y. M. (2017). Heart sound and abnormal heart sound detection method based on signal characteristic. International Journal of Mathematical Sciences and Engineering (IJMSE), 5(2), 99-103.
Shono, A., Mori, S., Yatomi, A., Kamio, T., Sakai, J., Soga, F., & Hirata, K. I. (2019). Ultimate Third Heart Sound. Internal Medicine, 58(17), 2535-2538.
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