S3 and S4 Heart Sounds in Cardiac Pathology

Clinical Significance of S3 and S4 Heart Sounds

• When heard over the mitral area, S3 typically indicates left ventricular dysfunction, while over the tricuspid area, it suggests right ventricular dysfunction, as noted by the American Heart Association in Circulation 1
• The American College of Cardiology recommends echocardiography as the first-line diagnostic test to evaluate the underlying cause of S3 and S4 heart sounds, with a study published in the Journal of the American College of Cardiology 2
• Echocardiography is also supported by Circulation as a key diagnostic tool for assessing cardiac pathology associated with S3 and S4 heart sounds 3
• The European Society of Cardiology suggests that assessment of patients with suspected heart failure should include evaluation of ventricular function and dimensions, as published in the European Journal of Heart Failure 4
• In patients with chronic thromboembolic pulmonary hypertension, an S3 or S4 gallop may be auscultated over the right ventricle as right-sided heart failure develops, according to research in Circulation 1