An S3 represents blood striking the walls of a stretched ventricle (heart chamber).

What Is the S3 Heart Sound?

To best understand theS3 heart sound, you must first understand how normalheart soundsS1 and S2are generated.

A healthcare provider uses a stethoscope to listen to heart sounds

Hispanolistic / Getty Images

The first heart sound,S1, comes up whenever the mitral and tricuspid valves close.

These valves close as the ventricles pump blood out of the heart into the lungs or bodythis is calledsystole.

The second heart sound,S2, happens when the aortic and pulmonary valves close.

These valves close as the ventricles relax and fill with bloodthis isdiastole.

S3may be present in healthy children or young adults.

AnS3is sometimes called a “ventricular gallop.”

In such cases, the third heart sound is usually harmless and not a sign of heart failure.

They may refer you tocardiac rehabilitation, an exercise program customized to optimize your heart health safely.

Medications

Heart failure medications help reduce symptoms and vary in throw in and dosing.

S3 Compared to Other Heart Sounds

A fourth heart soundS4is another abnormal heart sound.

LikeS3,S4is low-pitched and best heard with the bell of astethoscope.

The presence of a fourth heart sound reflects a stiff and inflexible left ventricle.

Heart murmursmay be harmless (“innocent”), sometimes heard in young children or during pregnancy.

Based on their medications, they will also undergo periodic blood tests (e.g., potassium level).

It can also be normal in athletes or during pregnancy.

National Heart, Lung, and Blood Institute.How blood flows through the heart.

Cascino T, Shea M.J.Cardiac auscultation.

Merck Manual Professional Version.

Meyer TE.Auscultation of heart sounds.

In: UpToDate, Gersch BJ, (Ed), Wolters Kluwer

Silverman ME.The Third Heart Sound.

InClinical Methods: The History, Physical, and Laboratory Examinations.

Walker HK, Hall WD, Hurst JW, editors.

Boston: Butterworths; 1990.

Chapter 24

American Heart Association.Dilated cardiomyopathy.

National Heart, Lung, and Blood Institute.What is coronary heart disease?

Armstrong GP.Overview of cardiac valvular disorders.

InMerck Manual Professional Version.

Merck & Co., Inc. 2023.

2020;133(6):e237-e248.

2019;139(13):1603-1611. doi:10.1161/CIRCULATIONAHA.117.031855

National Heart, Lung, and Blood Institute.Heart failure: treatment.

Meyer TE.Primary pharmacologic therapy for heart failure with reduced ejection fraction.

In: UpToDate, Gottlieb SS.

(Ed), Wolters Kluwer.

2017;33(5):410-416. doi:10.1016/j.joa.2017.03.002

American Heart Association.Heart failure signs and symptoms.