This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables.
In Reply.—I would agree with Dr Murphy that an S3 gallop and pulsus alternans are more specific to the heart and heart failure than, perhaps, dyspnea or edema. However, a third heart sound may be a physiologic finding in a child; a normal variant in a pregnant woman; a finding compatible with significant mitral regurgitation even without heart failure; or a finding of left ventricular dysfunction, with or without heart failure. Although a pulsus alternans may be seen with advanced myopathic conditions accompanied by congestive heart failure, it can also be seen with aortic stenosis without heart failure, as well as be produced under high afterload-low preload conditions. Therefore, despite the "traditional teachings of physical diagnosis," an S3 gallop and a pulsus alternans have never been, and thus, cannot remain "specific signs of heart failure."
KESSLER KM. Heart Failure Secondary to Diastolic Dysfunction-Reply. Arch Intern Med. 1989;149(7):1695. doi:10.1001/archinte.1989.00390070193037
Coronavirus Resource Center
Customize your JAMA Network experience by selecting one or more topics from the list below.