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