S3 Gallop
The S3 occurs during the rapid filling phase of early diastole (the y descent of the jugular venous waveform), 0.14-0.22 seconds after S2 (MUCH farther from S2 than a widely split S2). Unlike the split S2, the S3 is best heard over the apex of the heart using the bell of the stethoscope.
Patient 1:
This patient has an S3 gallop. Also note the presence of a crescendo-decrescendo systolic murmur.
S3 Gallop
Annotated
Patient 2:
This patient has an S3 gallop.
S3 Gallop
Annotated
Patient 3:
This patient has an S3 gallop in the context of severe mitral regurgitation. Notice the holosystolic murmur.
S3 Gallop
Annotated
Patient 4:
This is a young man with Laennec’s cirrhosis who developed high-output heart failure.
S3 Gallop
Annotated
Patient 5:
This is a young man with schizophrenia recently started on clozapine, who was admitted to the hospital with fever, chest pain, and elevated inflammatory markers, and was found to have an elevated JVP and an S3 gallop on exam. This constellation of findings led to a diagnosis of clozapine-induced myocarditis. Withdrawal of the drug resulted in rapid clinical improvement.
S3 Gallop
Annotated
Patient 6:
This patient
S3 Gallop
Annotated
Patient 7
This is an older woman with severe mitral regurgitation and tricuspid regurgitation. Note the holosystolic murmur and S3 gallop
Patient 8:
This is a middle-age man with ischemic cardiomyopathy complicated by chronic systolic heart failure, as well as a history of infective endocarditis involving the aortic and pulmonic valves, who was admitted to the hospital for an unrelated reason. He was noted to have a widely split S2 as well as an S3 gallop over the apex. Notice the duration between the two sounds of the split S2 is shorter than the duration between the S2 to the S3 gallop.
Patient 9:
This is a young man with a new diagnosis of biventricular heart failure of undetermined etiology, found to have an S3 gallop
Patient 10: