S3 (splash)

• ventricular gallop sound (after S2)

  caused by diastolic filling of the ventricle with tense papillary chordal apparatus (reduced intrinsic ventricular wall compliance)

It can occur in the following conditions:

• forceful, rapid filling of a ventricle that has normal or elevated compliance during diastole
• Normal or even decreased filling rates when ventricular compliance is low
• Blood flowing into an overfilled ventricle with high end-systolic volume

In short, suspect DILATED LEFT VENTRICLE

(best heard with the bell [low pitch] at the apex area while the patient is in the left lateral decubitus position at the end of expiration)

heard in left ventricular failure, restrictive cardiomyopathy and MR (high output states)

N.B.

In constrictive pericarditis, reduced ventricular compliance is occurred due to an external force. This results in a pericardial knock, a sharper, more accentuate sound heard earlier in diastole than the S3 sound.

  Gallop rhythm (S3) is an early sign of LVF and quite specific

  considered normal if < 30 years old (may persist in women up to 50 years old) and pregnant