Which heart sound is most indicative of ventricular failure in an older adult?

• A. S3
• B. S1
• C. S2
• D. S4

Answer: (A)

An S3 gallop after S2 is the sound most associated with ventricular failure in an older adult. It happens during the rapid filling phase of early diastole when a ventricle that’s volume-overloaded or dilated is suddenly filled. The rapid inflow creates a vibration that you hear as an extra low-pitched sound, best at the apex with the person in the left lateral position. In older patients, an S3 is typically abnormal and points to systolic heart failure with elevated filling pressures and fluid overload.

By contrast, an S4 sounds late in diastole from atrial contraction into a stiff, noncompliant ventricle and is more about diastolic dysfunction or hypertrophy rather than overt ventricular failure. S1 and S2 are normal valve closures and don’t specifically indicate heart failure.