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S3 Pathogenesis

S3: Pathogenesis & Clinical Findings Pathological Physiological Pregnancy High-output state (↑ volume flow in heart) Author: Yvette Ysabel Yao Reviewers: Stephanie Happ George Tadros Shahab Marzoughi Jonathaan Howlett* * MD at time of publication Athletes Prolonged training causes ↑ left ventricle size and ↑ blood volume in ventricle Tricuspid +/- mitral regurgitation (leaky tricuspid/ mitral valve) Heart Failure (See Left Heart Failure slide) Dilated cardiomyopathy (See Dilated cardiomyopathy slide) Pulmonary +/- aortic regurgitation (leaky pulmonary / aortic valve) Children and young adults Compliant ventricle rapidly expands in early diastole Diastole S1 Systole Diastole ↑ Blood volume flowing into ventricle from atrium after semilunar valves close (S2 heart sound) Diastolic overload (↑ filling of ventricles) Sudden intrinsic limitation of longitudinal expansion of the ventricular wall Large volume of blood striking a very compliant ventricular wall S3 (Low pitched, heard in early diastole, best heard apex in left lateral decubitus position with bell of stethoscope) S2 S3 Left ventricle is located more posteriorly and is relatively unaffected by changes in intrathoracic pressure Left ventricle S3 (unchanged or sometimes increased with expiration) Anterior right ventricle more sensitive to negative intrathoracic pressure ↑ Venous return to right ventricle during inspiration Right ventricle S3 (best heard along the lower left sternal border, intensity increases with inspiration) Legend: Pathophysiology Mechanism Sign/Symptom/Lab Finding Complications Published Sep 18, 2024 on www.thecalgaryguide.com