Third heart sound: genesis and clinical importance

Mehta, Nirav; Khan, Ijaz A.

doi:10.1016/j.ijcard.2003.05.031

Cited by 39 publications

(29 citation statements)

References 33 publications

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“…The third heart sound (S3), which is caused by rapid deceleration of the blood against a stiff ventricle during early diastolic filling, is regarded as one of the earliest signs of HF. 5,6 The S3 is also known to be moderately sensitive but highly specific to elevated left ventricular (LV) filling pressures 7,8 and predictive of 1-year mortality. 9 An implanted device-based S3 sensor can serve as a useful surrogate for intracardiac haemodynamics 10 without requiring an additional procedure to implant a dedicated intravascular device.…”

Section: Introductionmentioning

confidence: 99%

Haemodynamic monitoring of cardiac status using heart sounds from an implanted cardiac device

Thakur

Swanson

et al. 2017

ESC Heart Failure

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AimThe aim of this study was to evaluate the haemodynamic correlates of heart sound (HS) parameters such as third HS (S3), first HS (S1), and HS‐based systolic time intervals (HSTIs) from an implantable cardiac device.Methods and resultsTwo unique animal models (10 swine with myocardial ischaemia and 11 canines with pulmonary oedema) were used to evaluate haemodynamic correlates of S1, S3, and HSTIs, namely, HS‐based pre‐ejection period (HSPEP), HS‐based ejection time (HSET), and the ratio HSPEP/HSET during acute haemodynamic perturbations. The HS was measured using implanted cardiac resynchronization therapy defibrillator devices simultaneously with haemodynamic references such as left atrial (LA) pressure and left ventricular (LV) pressure. In the ischaemia model, S1 amplitude (r = 0.76 ± 0.038; P = 0.002), HSPEP (r = −0.56 ± 0.07; P = 0.002), and HSPEP/HSET (r = −0.42 ± 0.1; P = 0.002) were significantly correlated with LV dP/dtmax. In contrast, HSET was poorly correlated with LV dP/dtmax (r = 0.14 ± 0.14; P = 0.23). In the oedema model, a physiological delayed response was observed in S3 amplitude after acute haemodynamic perturbations. After adjusting for the delay, S3 amplitude significantly correlated with LA pressure in individual animals (r = 0.71 ± 0.07; max: 0.92; min: 0.17) as well as in aggregate (r = 0.62; P < 0.001). The S3 amplitude was able to detect elevated LA pressure, defined as >25 mmHg, with a sensitivity = 58% and specificity = 90%.ConclusionsThe HS parameters such as S1, S3, and HSTIs measured using implantable devices significantly correlated with haemodynamic changes in acute animal models, suggesting potential utility for remote heart failure patient monitoring.

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Section: Introductionmentioning

confidence: 99%

Haemodynamic monitoring of cardiac status using heart sounds from an implanted cardiac device

Thakur

Swanson

et al. 2017

ESC Heart Failure

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“…5,23,24 Although debate regarding the mechanisms underlying S3 has persisted, a ventricular origin (i.e., ventricular vibrations as a consequence of rapid filling in early diastole) is most widely accepted. 23, 24 It is important to note that physiological S3 is common in healthy children and adolescents, 5 even in adults approaching their 40 s. 25 Nevertheless, S3 in the present study was considered to be pathological because of the age of the patients (i.e., 57 years on average) and underlying cardiac conditions (i.e., myocardial hypertrophy associated with HCM).…”

Section: Discussionmentioning

confidence: 66%

Third and Fourth Heart Sounds and Myocardial Fibrosis in Hypertrophic Cardiomyopathy

Sato

Kawasaki

Honda

et al. 2018

Circ J

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Methods Study PopulationThe present retrospective study was performed on 53 consecutive patients with HCM (mean age 66 years; range 37-91 years) who underwent an initial assessment, including phonocardiography, echocardiography, LGE-MRI, and biomarker measurements, in Matsushita Memorial Hospital. All patients were clinically stable without symptoms of heart failure, such as dyspnea, fatigue, and edema. Although these initial examinations were not necessarily performed on the same day, there were no patients with clinical conditions that changed over the period of the assessments. The diagnosis of HCM was based on the conventional echocardiographic demonstration of LV end-diastolic thickness ≥15 mm and LV end-diastolic diameter (LVEDD) ≤55 mm in the absence of any cardiac or systemic disorder that may cause LV hypertrophy, such as severe hypertension, defined as blood pressure ≥160/100 mmHg, or aortic stenosis, defined as an aortic valve area <1.5 cm 2 . Exclusion criteria were non-sinus rhythm, a previous history of myocardial T he 4th heart sound (S4) is commonly heard in patients with hypertrophic cardiomyopathy (HCM) with a sinus rhythm. 1,2 The derivation of S4 may be the result of a forceful left atrial contraction into a noncompliant left ventricle (LV). 3,4 The third heart sound (S3) is also heard, although less frequently than S4, in patients with HCM regardless of the presence or absence of heart failure. 1,2 The exact mechanism responsible for S3 in HCM patients remains unclear, reduced LV compliance due to myocardial hypertrophy has been proposed. 5 Patients with HCM often develop LV myocardial fibrosis, which may be assessed non-invasively using late gadolinium enhancement (LGE) magnetic resonance imaging (MRI). 6,7 In addition to myocardial hypertrophy, myocardial fibrosis can alter LV compliance, which leads to the development of S4 and S3; however, limited information is available on the effects of myocardial fibrosis on these extra heart sounds in patients with HCM. Thus, the aims of the present study were to examine the relationships between myocardial fibrosis, as assessed by LGE-MRI, and S3 and S4 in patients with HCM.

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“…La sensibilidad y especifi cidad para cada síntoma, signo y examen útiles en el diagnóstico de la IC se revisa en la tabla 1 [13,16,[19][20][21][22][23][24][25][26][27][28][29].…”

Section: ¿Se Despierta Ahogado En La Noche?unclassified

“…El S3 en pacientes menores de 40 años no se asocia a procesos patológicos. En pacientes mayores de 40 años indica una disfunción sistólica severa y está relacionado con sobrecarga de volumen [27]. La presencia de S3 se asocia a mayor número de hospitalizaciones y peor pronóstico [66].…”

Section: ¿Se Despierta Ahogado En La Noche?unclassified

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Semiología y diagnóstico diferencial de la insuficiencia cardíaca crónica

Giraldo

Salazar

Buitrago-Toro

et al. 2018

Rev. Médica Risaralda

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Resumen: la insuficiencia cardiaca es un síndrome clínico de etiología multifactorial de alta prevalencia en la población mundial y latinoamericana debido al aumento en la expectativa de vida. Actualmente el diagnóstico de este se basa en los hallazgos de pruebas diagnósticas como el ecocardiograma o pépticos natriuréticos, pero es importante para el personal médico conocer e identificar de manera clara los signos y síntomas que presentan los pacientes con insuficiencia cardiaca, pues es una tendencia actual el desconocer datos semiológicos importantes que fueron descritos y refinados durante los siglos XIX y XX, y que ahora son validados por la medicina basada en la evidencia. Lo anterior cobra importancia pues el papel que debe tener la creciente tecnología no es acabar o desplazar el conocimiento clínico, si no ser una herramienta complementaria para el buen cuidado del paciente y así llegar al mejor desenlace posible.Este artículo pretende brindar datos basados en la evidencia para hacer de la clínica la parte fundamental del proceso diagnóstico y de la relación médico paciente. También intenta ser una guía útil para estudiantes de medicina o médicos que se desenvuelven en sitios con pocos recursos económicos, ya que la elección adecuada de un examen diagnóstico solo puede ser llevada a cabo mediante un buen interrogatorio y examen físico.Palabras clave: insuficiencia cardiaca; Diagnóstico; Signos y Síntomas; Colombia Copyright © Facultad de Ciencias de la Salud de la Universidad Tecnológica de Pereira. 1995-2017. Todos los derechos reservados ® Semiology and differential diagnosis of chronic heart failure Abstract: heart failure is a clinical syndrome with multifactorial etiology of high prevalence in the world and Latin American population due to the increase in life expectancy. Currently the diagnosis of this is based on the findings of diagnostic tests such as echocardiogram or natriuretic peptic, but it is important for the medical staff to know and clearly identify the signs and symptoms that patients with heart failure present, as it is a current trend To ignore important semiological data that were described and refined during the nineteenth and twentieth centuries, and which are now validated by evidencebased medicine. This is important because the role of growing technology is not to end or displace clinical knowledge, if not to be a complementary tool for good patient care and thus reach the best possible outcome.This article aims to provide data based on the evidence to make the clinic the fundamental part of the diagnostic process and the patient medical relationship. It is also intended to be a useful guide for medical students or physicians operating in poorly funded areas, as the proper choice of a diagnostic examination can only be carried out through a thorough examination and physical examination.Key words: heart failure; Diagnosis; Signs and Symptoms; Colombia Copyright © Facultad de Ciencias de la Salud de la Universidad Tecnológica de Pereira. 1995-2017. All rights reserved ®. Introducc...

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Third heart sound: genesis and clinical importance

Cited by 39 publications

References 33 publications

Haemodynamic monitoring of cardiac status using heart sounds from an implanted cardiac device

Haemodynamic monitoring of cardiac status using heart sounds from an implanted cardiac device

Third and Fourth Heart Sounds and Myocardial Fibrosis in Hypertrophic Cardiomyopathy

Semiología y diagnóstico diferencial de la insuficiencia cardíaca crónica

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