third heart sound

III音

WordNet

1. thorough; "a sound thrashing"
2. mechanical vibrations transmitted by an elastic medium; "falling trees make a sound in the forest even when no one is there to hear them"
3. the particular auditory effect produced by a given cause; "the sound of rain on the roof"; "the beautiful sound of music"
4. the subjective sensation of hearing something; "he strained to hear the faint sounds" (同)auditory sensation
5. a large ocean inlet or deep bay; "the main body of the sound ran parallel to the coast"
6. the sudden occurrence of an audible event; "the sound awakened them"
7. make a certain noise or sound; "She went `Mmmmm"; "The gun went `bang" (同)go
8. announce by means of a sound; "sound the alarm"
9. appear in a certain way; "This sounds interesting"
10. cause to sound; "sound the bell"; "sound a certain note"
11. financially secure and safe; "sound investments"; "a sound economy"
12. free from moral defect; "a man of sound character"
13. give off a certain sound or sounds; "This record sounds scratchy"
14. in good condition; free from defect or damage or decay; "a sound timber"; "the wall is sound"; "a sound foundation"
15. a plane figure with rounded sides curving inward at the top and intersecting at the bottom; conventionally used on playing cards and valentines; "he drew a heart and called it a valentine"
16. the courage to carry on; "he kept fighting on pure spunk"; "you havent got the heart for baseball" (同)mettle, nerve, spunk
17. an inclination or tendency of a certain kind; "he had a change of heart" (同)spirit
18. a playing card in the major suit that has one or more red hearts on it; "he led the queen of hearts"; "hearts were trumps"
19. the locus of feelings and intuitions; "in your heart you know it is true"; "her story would melt your bosom" (同)bosom
20. the hollow muscular organ located behind the sternum and between the lungs; its rhythmic contractions move the blood through the body; "he stood still, his heart thumping wildly" (同)pump, ticker
21. a firm rather dry variety meat (usually beef or veal); "a five-pound beef heart will serve six"
22. able to perceive sound
23. an opportunity to state your case and be heard; "they condemned him without a hearing"; "he saw that he had lost his audience" (同)audience
24. (law) a proceeding (usually by a court) where evidence is taken for the purpose of determining an issue of fact and reaching a decision based on that evidence
25. the ability to hear; the auditory faculty; "his hearing was impaired" (同)audition, auditory sense, sense of hearing, auditory modality
26. a session (of a committee or grand jury) in which witnesses are called and testimony is taken; "the investigative committee will hold hearings in Chicago"
27. in the third place; "third we must consider unemployment" (同)thirdly
28. following the second position in an ordering or series; "a distant third"; "he answered the first question willingly, the second reluctantly, and the third with resentment"
29. the musical interval between one note and another three notes away from it; "a simple harmony written in major thirds"
30. coming next after the second and just before the fourth in position (同)3rd, tertiary
31. receive a communication from someone; "We heard nothing from our son for five years"
32. examine or hear (evidence or a case) by judicial process; "The jury had heard all the evidence"; "The case will be tried in California" (同)try
33. perceive (sound) via the auditory sense

PrepTutorEJDIC

1. 〈C〉〈U〉『音』,『音響』,響き・〈U〉音の聞こえる範囲・〈C〉(音声としての)音 / 《単数形で》(聞いたり,読んだりしたときに受ける)感じ,響き,調子・〈U〉(無意味な)音(声);騒音,ざわめき・『音を出す』,鳴る,響く・『聞こえる,思える』(進行形にできない) ・〈楽器・ベルなど〉‘を'鳴らす・(音で)…‘を'知らせる・…‘を'発音する・〈考えなど〉‘を'打診する
2. (物が)『傷んでいない』,腐っていない,完全な / (心身が)『健全な』,健康な / (財政的に)『安定した』,堅実な / (論理・判断などが)『的確な』,もっともな,分別ある / 合法的な / (道徳的に)高潔な,誠実な / (睡眠が)深い / 徹底した,思う存分の / ぐっすりと
3. (重りのついた糸で)〈海・川など〉‘の'水深を測る / (…について)〈意見・態度など〉‘を'さぐる,調べる《+『名』+『out』(+『out』+『名』)+『about』+『名』》 / 水深を測る / 〈鯨・魚などが〉深く潜る
4. 海峡,瀬戸(strait) / 入り江
5. 〈C〉『心臓』;胸 / 〈C〉(感情の中心をなす)『心』,気持ち / 〈U〉愛情,同情 / 〈U〉『勇気』,元気,熱意 / 《the ~》『中心』,内部,(物事の)本質,核心 / 〈C〉ハート形の物;(カードの)ハートの札
6. 〈U〉『聴力』,聴覚〈U〉〈C〉(…を)『聞くこと』,(…の)聞き取り《+『of』+『名』》・〈C〉聞いてもらう機会,聞いてやること・聴取・聴聞会〈C〉(法廷などでの)尋問,審問,;(刑罰の減免を求める)釈明,意見陳述 / 〈U〉聞こえる距離(範囲)
7. 《the ~》『第3番目の』,3番目の / 3分の1の / 《the ~》『第3』,3番目[のもの],(月の)『3日』 / 〈C〉『3分の1』 / 〈C〉(音楽で)3度[音程] / 〈U〉(自動車などの)サード(第3速)[ギア] / 第3に,3番目に
8. 〈音〉‘が'『聞こえる』,‘を'聞く(進行形にできない) / 〈人の言うこと〉‘に'『耳を傾ける』,‘を'注意深く聞く(listen);(裁判官などが)…の申し立てを聞く / 〈うわさ・ニュースなど〉‘を'『耳にしている』,聞いている / 『耳が聞こえる』 / 《しばしば命令形で》耳を傾ける,注意を向ける / 『うわさ』(『消息』)『を聞く』

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/11/24 21:25:40」(JST)

wiki en

[Wiki en表示]

Third heart sound
Classification and external resources
ICD-9	427.9, 785.3
DiseasesDB	13037

Diagram of the heart.

The third heart sound or S₃ is a rare extra heart sound that occurs soon after the normal two "lub-dub" heart sounds (S₁ and S₂). The S3 is associated with heart failure.

Physiology

It occurs at the beginning of diastole, approximately 0.12 to 0.18 seconds after S₂. This produces a rhythm classically compared to the cadence of the word "Kentucky" with the final syllable ("-ky") representing S₃. One may also use the phrase "SLOSH’-ing-in" to help with the cadence (SLOSH S₁, -ing S₂, -in S₃), as well as the pathology of the S₃ sound., or any other number of local variants.

S₃ may be normal in people under 40 years of age and some trained athletes but should disappear before middle age. Re-emergence of this sound late in life is abnormal and may indicate serious problems like heart failure. The sound of S₃ is lower in pitch than the normal sounds, usually faint, and best heard with the bell of the stethoscope.

It has also been termed a ventricular gallop or a protodiastolic gallop because of its place in early diastole. It is a type of gallop rhythm by virtue of having an extra sound; the other gallop rhythm is called S₄. The two are quite different, but they may sometimes occur together forming a quadruple gallop. If the heart rate is also very fast (tachycardia), it can become difficult to distinguish between S₃ and S₄ thus producing a single sound called a summation gallop. S₃ is a dull, low-pitched sound best heard with the bell placed over the cardiac apex with the patient lying in the left lateral decubitus position. This heart sound when present in a child or young adult implies the presence of a supple ventricle that can undergo rapid filling. Conversely, when heard in a middle-aged or older adult, an S₃ is often a sign of disease, indicating increased ventricular filling due to congestive heart failure or severe mitral or tricuspid regurgitation.

Causes

S₃ is thought to be caused by the oscillation of blood back and forth between the walls of the ventricles initiated by the inflow of blood from the atria. The reason the third heart sound does not occur until the middle third of diastole is probably because during the early part of diastole, the ventricles are not filled sufficiently to create enough tension for reverberation. It may also be a result of tensing of the chordae tendineae during rapid filling and expansion of the ventricle.

Associations

It is associated with heart failure, caused by conditions which have:

Rapid ventricular filling

• Mitral regurgitation - this is when one of the mitral valve leaflets that usually stop blood flowing from the left ventricle to the left atrium fails, allowing blood into the atria during systole. This means that the left atrium will be overfilled, leading to rapid ventricular filling when the mitral valve opens.
• Elevated left atrial and left ventricular filling pressures, usually a result of a stiffened and dilated left ventricle
• Ventricular septal defect - this is a hole in the wall between the two ventricles, which allows rapid filling from the other ventricle.

Poor left ventricular function

• Post-MI - the death of tissue in the ventricular wall due to loss of blood supply causes wall areas which do not move as well as normal (hypokinesia), or not at all (akinesia), meaning they relax more slowly, so the ventricular filling is relatively too rapid.
• Dilated cardiomyopathy - the ventricular walls are abnormal for a variety of reasons, and become thin and stiff so do not relax well.

S3 can also be due to tricuspid regurgitation, and could indicate hypertensive heart disease.

In conditions affecting the pericardium or diseases that primarily affect the heart muscle (restrictive cardiomyopathies) a similar sound can be heard, but is usually more high-pitched and is called a 'pericardial knock'.

The S3 can also be confused with a widely split S2, or a mitral opening snap, but these sounds are typically of much higher pitch and occur closer to the onset of S2.

Treatment

The condition itself does not need to be treated, but rather the underlying cause requires correction. Depending on the aetiology the gallop rhythm may resolve spontaneously.

References

External links

• chfpatients.com - suitable for non-medical people, but requires some knowledge of medical terms
• KUO PT, SCHNABEL TG, BLAKEMORE WS, WHEREAT AF (1957). "Diastolic Gallop Sounds, the Mechanism of Production". J. Clin. Invest. 36 (7): 1035–42. doi:10.1172/JCI103499. PMC 1072690. PMID 13449156. 

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

• 1. 心音の聴診 auscultation of heart sounds
• 2. 心不全が疑われる患者の評価 evaluation of the patient with suspected heart failure
• 3. 幼児および小児における心疾患の疑い：紹介の基準 suspected heart disease in infants and children criteria for referral
• 4. 狭心症：心筋虚血による胸痛 angina pectoris chest pain caused by myocardial ischemia
• 5. 小児における身体的診察：胸部および腹部 the pediatric physical examination chest and abdomen

English Journal

• Details of left ventricular radial wall motion supporting the ventricular theory of the third heart sound obtained by cardiac MR.

• Codreanu I1, Robson MD, Rider OJ, Pegg TJ, Dasanu CA, Jung BA, Rotaru N, Clarke K, Holloway CJ.Author information 1Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK.AbstractObjective: Obtaining new details of radial motion of left ventricular (LV) segments using velocity-encoding cardiac MRI. Methods: Cardiac MR examinations were performed on 14 healthy volunteers aged between 19 and 26 years. Cine images for navigator-gated phase contrast velocity mapping were acquired using a black blood segmented κ-space spoiled gradient echo sequence with a temporal resolution of 13.8 ms. Peak systolic and diastolic radial velocities as well as radial velocity curves were obtained for 16 ventricular segments. Results: Significant differences among peak radial velocities of basal and mid-ventricular segments have been recorded. Particular patterns of segmental radial velocity curves were also noted. An additional wave of outward radial movement during the phase of rapid ventricular filling, corresponding to the expected timing of the third heart sound, appeared of particular interest. Conclusion: The technique has allowed visualization of new details of LV radial wall motion. In particular, higher peak systolic radial velocities of anterior and inferior segments are suggestive of a relatively higher dynamics of anteroposterior vs lateral radial motion in systole. Specific patterns of radial motion of other LV segments may provide additional insights into LV mechanics. Advances in knowledge: The outward radial movement of LV segments impacted by the blood flow during rapid ventricular filling provides a potential substrate for the third heart sound. A biphasic radial expansion of the basal anteroseptal segment in early diastole is likely to be related to the simultaneous longitudinal LV displacement by the stretched great vessels following repolarization and their close apposition to this segment.
• The British journal of radiology.Br J Radiol.2014 May;87(1037):20130780. doi: 10.1259/bjr.20130780. Epub 2014 Feb 24.
• Objective: Obtaining new details of radial motion of left ventricular (LV) segments using velocity-encoding cardiac MRI. Methods: Cardiac MR examinations were performed on 14 healthy volunteers aged between 19 and 26 years. Cine images for navigator-gated phase contrast velocity mapping were acquire
• PMID 24641347

• Alcohol and cardiovascular health: the dose makes the poison…or the remedy.

• O'Keefe JH1, Bhatti SK2, Bajwa A2, DiNicolantonio JJ2, Lavie CJ3.Author information 1Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, MO. Electronic address: jokeefe@saint-lukes.org.2Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, MO.3John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, LA.AbstractHabitual light to moderate alcohol intake (up to 1 drink per day for women and 1 or 2 drinks per day for men) is associated with decreased risks for total mortality, coronary artery disease, diabetes mellitus, congestive heart failure, and stroke. However, higher levels of alcohol consumption are associated with increased cardiovascular risk. Indeed, behind only smoking and obesity, excessive alcohol consumption is the third leading cause of premature death in the United States. Heavy alcohol use (1) is one of the most common causes of reversible hypertension, (2) accounts for about one-third of all cases of nonischemic dilated cardiomyopathy, (3) is a frequent cause of atrial fibrillation, and (4) markedly increases risks of stroke-both ischemic and hemorrhagic. The risk-to-benefit ratio of drinking appears higher in younger individuals, who also have higher rates of excessive or binge drinking and more frequently have adverse consequences of acute intoxication (for example, accidents, violence, and social strife). In fact, among males aged 15 to 59 years, alcohol abuse is the leading risk factor for premature death. Of the various drinking patterns, daily low- to moderate-dose alcohol intake, ideally red wine before or during the evening meal, is associated with the strongest reduction in adverse cardiovascular outcomes. Health care professionals should not recommend alcohol to nondrinkers because of the paucity of randomized outcome data and the potential for problem drinking even among individuals at apparently low risk. The findings in this review were based on a literature search of PubMed for the 15-year period 1997 through 2012 using the search terms alcohol, ethanol, cardiovascular disease, coronary artery disease, heart failure, hypertension, stroke, and mortality. Studies were considered if they were deemed to be of high quality, objective, and methodologically sound.
• Mayo Clinic proceedings.Mayo Clin Proc.2014 Mar;89(3):382-93. doi: 10.1016/j.mayocp.2013.11.005.
• Habitual light to moderate alcohol intake (up to 1 drink per day for women and 1 or 2 drinks per day for men) is associated with decreased risks for total mortality, coronary artery disease, diabetes mellitus, congestive heart failure, and stroke. However, higher levels of alcohol consumption are as
• PMID 24582196

• Prognostic value of the physical examination in patients with heart failure and atrial fibrillation: insights from the AF-CHF trial (atrial fibrillation and chronic heart failure).

• Caldentey G1, Khairy P2, Roy D1, Leduc H3, Talajic M1, Racine N1, White M1, O'Meara E1, Guertin MC3, Rouleau JL1, Ducharme A4.Author information 1Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.2Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada; Montreal Heart Institute Coordinating Center, Montreal, Quebec, Canada.3Montreal Heart Institute Coordinating Center, Montreal, Quebec, Canada.4Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada. Electronic address: anique.ducharme@umontreal.ca.AbstractOBJECTIVES: This study sought to assess the prognostic value of physical examination in a modern treated heart failure population.
• JACC. Heart failure.JACC Heart Fail.2014 Feb;2(1):15-23. doi: 10.1016/j.jchf.2013.10.004. Epub 2014 Jan 8.
• OBJECTIVES: This study sought to assess the prognostic value of physical examination in a modern treated heart failure population.BACKGROUND: The physical examination is the cornerstone of the evaluation and monitoring of patients with heart failure. Yet, the prognostic value of congestive signs (i.
• PMID 24622114

Japanese Journal

• Need for Better Blood Pressure Measurement in Developing Countries to Improve Prevention of Cardiovascular Disease

• Modesti Pietro Amedeo,Perruolo Eleonora,Parati Gianfranco
• Journal of Epidemiology, 2015
• … Implementation of global prevention efforts urgently needs to be accelerated because of the increasing incidence of haemorrhagic stroke, renal failure, and hypertensive heart disease in developing countries. …
• NAID 130004704586

• Physiological basis and clinical significance of left ventricular suction studied using echo-dynamography

• TANAKA Motonao,SAKAMOTO Tsuguya,SUGAWARA Shigeo,NAKAJIMA Hiroyuki,KAMEYAMA Takeyoshi,TABUCHI Haruna,KATAHIRA Yoshiaki,OHTSUKI Shigeo,KANAI Hiroshi
• Journal of cardiology 58(3), 232-244, 2011-11-15
• NAID 10031159598

• 無償幼稚園における子どもの生活形態と母親教育 : ケート・D・ウィギンの実践を通して

• 橋川 喜美代
• 鳴門教育大学研究紀要 22, 86-95, 2007
• … It was obvious about Kate Douglas Wiggin's educational practice that she had taken thoroughly to heart Emma Marwedel's teaching that modification in materials and methods must be made but that Froebel's principles were sound to even the point of implementation. … Third, every child should have the right to a place of his own with appropriate surroundings which have some relation to his size, desires and capabilities. …
• NAID 110006184880

Related Links

• Third heart sound - definition of third heart sound by Medical ...

third heart sound (S 3), occurs in early diastole and corresponds with the end of the first phase of rapid ventricular filling; normal in children and younger people but abnormal in others. Synonym(s): third sound third heart sound n. The ...

• Third Heart Sound - YouTube

This is the sound of third heart sound. Remember that S3 occurs after S2 while S4 occors before S1

Related Pictures

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★リンクテーブル★

リンク元	「III音」
関連記事	「sound」「hearing」「hear」「heart」

「III音」

　　[★]

英

third heart sound, S3 heart sound S3

関

心音、過剰心音、IV音

タイミング

• 収縮の初期。房室弁の開放に続く。心室急速充満期。

I-II-III

部位

• left-sided:apex
• right-sided:sternal border

音

• dull, pitch：low. bell of the stethoscope
• left-sided S3:the left lateral decubitus positionの時に心尖で大きく聞こえる

病態生理

• 簡単に言えば、「容量負荷」
• 1. 腱索が、血液が急に充満し心室が拡張するときに張力で緊張した(引っ張られた)結果起こるように見える(PHD.37)
• 2. 急速流入期の血流による衝撃を心室壁の伸展によって逃がすことができず、衝突音が生じる(手技見え p.105)
• 3. 急速流入期における心房から心室への流入血液量の異常な増加あるいは心筋緊張度の低下、心室収縮終期容量の増加に伴って起こる心室内の振動の増加(IMD.95)

III音を生じる病態

病的

• 心房から心室への流入血液量の異常な増加　：僧帽弁閉鎖不全症(MR)、右-左シャントのある疾患(心室中隔欠損、動脈管開存症)
• 心筋緊張度の低下、心室収縮終期容量の増加：うっ血性心不全、拡張型心筋症(DCM)、大動脈弁閉鎖不全症(AR)

生理的

• 子供、若年者(20-30歳)、妊婦：正常(生理的III音)
• 成人：うつ血心不全など起因する容量負荷。うっ血性心不全・MR・DCM(手技見え p.105)。 ←　これは生理的ではない

QB.C-15

• 拡張期流入血液増加：MR,AS
• 心室コンプライアンス低下：DCM, MI後のcardiomegaly, heart failure

III音の増強

• 静脈還流量が増加するような条件、例えば下肢の挙上

「sound」

　　[★]

• n.

• 音

• v.

• 響く

• adj.

• 健全な

Use of the amblyopic eye is encouraged by discouraging use of the sound eye with an occluding patch or using drugs or glasses to blur vision in the sound eye.

関

salutary、tone

　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　

「hearing」

　　[★]

• n。

• 聴力、聴覚。聞くこと、聴取。聞こえる距離/範囲。聞いてやること、傾聴。聞いてもらうこと、発言の機会。(委員会などの)聴聞会、ヒアリング。(法)審問、尋問。

　 　 　 　 　 　

「hear」

　　[★]

• v.

• 聞く、聞こえる

　 　 　 　

「heart」

　　[★] 心臓