Rosh Emergency Medicine Practice Test

Which heart sound is associated with a patient presenting with symptoms of heart failure?

1. Crescendo-decrescendo midsystolic murmur

2. Midsystolic click

3. S3 heart sound

4. S4 heart sound

The correct answer is: S3 heart sound

The S3 heart sound, also known as the "ventricular gallop," is often associated with heart failure, particularly in the setting of volume overload or decreased ventricular compliance. In patients with heart failure, the S3 can provide valuable clinical information as it reflects rapid filling of the ventricles during the early diastolic phase, indicating that the heart is under stress and may not be able to handle the volume effectively. The presence of an S3 sound suggests that the ventricles are filled with an excessive volume of blood, which is common in conditions such as congestive heart failure. This is particularly true in patients with left heart failure, where the increased fluid volume leads to a higher probability of this heart sound being auscultated during physical examination. In contrast, other heart sounds mentioned have different implications. For instance, a midsystolic click is often related to mitral valve prolapse and is not directly indicative of heart failure. The crescendo-decrescendo midsystolic murmur typically indicates conditions like aortic stenosis rather than heart failure specifically. The S4 heart sound, also known as an "atrial gallop," often indicates a stiff or hypertrophied left ventricle and usually suggests diastolic dysfunction more than a