It is usually heard best while listening along the right or left lower sternal edge, in the epigastrium, or rarely over the jugular veins. The examiner is palpating the apical impulse while listening with the bell of the stethoscope applied near the apex.Ī right ventricular third heart sound is an uncommon finding heard in association with right ventricular dysfunction from a variety of causes.
The patient has been turned to a 30° left lateral position. Technique of patient examination for a ventricular gallop. Simultaneous palpation and inspection of the apex is useful however, a third heart sound is rarely palpable or visible when it is not audible. The bell of the stethoscope is then glided around the apical and lower sternal area seeking for a left ventricular gallop. The patient should be asked to exhale and suspend respiration temporarily in order to provide maximal silence to listen. The examiner then listens selectively for the third heart sound-tuning in to early diastole for low-frequency sounds while ignoring all other heart sounds and murmurs. After the apical impulse is located by careful palpation, the bell of the stethoscope is placed lightly over the apex. The left lateral position is of critical importance because the ventricular gallop is often heard only with the patient turned to the side. The patient is examined supine and then turned to a 30° left lateral position with the left arm extended upward away from the chest and the weight comfortably supported by the left hip, lateral chest, and left arm ( Figure 24.2). The bed should be elevated to a comfortable level for the examiner. The inexperienced ear is unaccustomed to listening for a sound of this low frequency.Īll extraneous noises-radio, television, visitors, hall noises-should be excluded so that the room is as quiet as possible. The usual frequency (pitch) of the sound is near the lowest level that the human ear can detect.
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