JACC Vol, 19. No. 2 February 1992_455-9

458

Editorial

Comment

Evaluation of Century-Old Physical Signs, S 3 and S 4 , by Modern Technology* SAMUEL ZONERAICH, MD, FACC Brors crd

FL_hing . New York

At the turn of this century, Potain (1) termed the third (S 3 ) and fourth (S4 ) heart sounds "bruits de gallop" (gallop sounds). In 1909 Thayer (2) correlated S 3 with the rapid filling phase and S4 with atria) systole, setting the stage for clinical and experimental studies in this new and exciting field . For many decades, clinicians and researchers used various techniques for timing and recording the low frequency (20 to 50 Hz) vibrations of the chest and applied their findings to physiologic and pathologic events (3) . Recently, two-dimensional Doppler echocardiography related S3 and Se to diastolic velocity curves (E and A waves) (4) . Modern advances in clinical cardiology have strengthened the diagnostic usefulness of S3 and S 4 in cardiac conditions . Compared with objective signs of congestive hear( failure (for example, ejection fraction