Skip to main content
SpringerLink
Log in

Accuracy and reliability of apical S3 gallop detection

  • Brief Reports
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

Abstract

This study assessed physician performance in detecting the apical S3 gallop using a cardiology patient simulator. Six physicians (two cardiology fellows, two medicine residents, and two attending physicians) performed two sets of 24 cardiac examinations that included the presence or absence of an apical S3 gallop. All the examiners were able to significantly alter the prior odds of an apical S3 gallop’s being present, but the cardiology fellows had higher sensitivities. Sensitivity was lower for detecting soft S3 gallops, and specificity was lower when a diastolic murmur was also present. Physician performance in detecting apical S3 gallops is variable, but can be excellent.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

References

  1. Harlan WR, Oberman A, Grimm R, Rosati RA. Chronic congestive heart failure in coronary heart disease: clinical criteria. Ann Intern Med. 1977;86:133–8.

    PubMed  CAS  Google Scholar 

  2. Mattleman SJ, Hakki A, Iskandrian AS, Segal BL, Kane SA. Reliability of bedside evaluation in determining left ventricular function: correlation with left ventricular ejection fraction determined by radionuclide ventriculography. J Am Coll Cardiol. 1983;1:417–20.

    Article  PubMed  CAS  Google Scholar 

  3. Gadsboll N, Hoilund-Carlsen PF, Nielsen GG, et al. Interobserver agreement and accuracy of bedside estimation of right and left ventricular ejection fraction in acute myocardial infarction. Am J Cardiol. 1989;63:1301–7.

    Article  PubMed  CAS  Google Scholar 

  4. Folland ED, Kriegel BJ, Henderson WG, Hammermeister KE, Sethi GK. Implications of third heart sounds in patients with valvular heart disease. N Engl J Med. 1992;327:458–62.

    Article  PubMed  CAS  Google Scholar 

  5. Goldman L, Caldera DL, Nussbaum SR, et al. Multifactorial index of cardiac risk in noncardiac surgical procedures. N Engl J Med. 1977;297:845–50.

    Article  PubMed  CAS  Google Scholar 

  6. Detsky AS, Abrams HB, McLaughlin JR, et al. Predicting cardiac complications in patients undergoing non-cardiac surgery. J Gen Intern Med. 1986;1:211–9.

    Article  PubMed  CAS  Google Scholar 

  7. Lee DC-S, Johnson RA, Bingham JB, et al. Heart failure in outpatients: a randomized trial of digoxin versus placebo. N Engl J Med. 1982;306:699–705.

    Article  PubMed  CAS  Google Scholar 

  8. Guyatt GH, Sullivan MJJ, Fallen EL, et al. A controlled trial of digoxin in congestive heart failure. Am J Cardiol. 1988;61:371–5.

    Article  PubMed  CAS  Google Scholar 

  9. Mulrow CD, Feussner JR, Velez R. Evaluation of digitalis efficacy: new light on an old leaf. Ann Intern Med. 1984;101:133–7.

    Google Scholar 

  10. Raftery EB, Holland WW. Examination of the heart: an investigation into variation. Am J Epidemiol. 1987;85:438–44.

    Google Scholar 

  11. Held P, Lindberg B, Swedberg K. Audibility of an artificial third heart sound in relation to its frequency, amplitude, delay from the second heart sound and the experience of the observer. Am J Cardiol. 1984;53:1169–72.

    Article  PubMed  CAS  Google Scholar 

  12. Sloan AW, Campbell FW. Henderson AS. Incidence of the physiological third heart sound. Br Med J. 1952;2:853–5.

    Article  PubMed  CAS  Google Scholar 

  13. Ishmail AA, Wing S, Ferguson J, Hutchinson TA, Magder S, Flegel KM. Interobserver agreement by auscultation in the presence of a third heart sound in patients with congestive heart failure. Chest. 1987;91:870–3.

    PubMed  CAS  Google Scholar 

  14. Mangione S, Nieman LZ, Gracely E, Kaye D. The teaching and practice of cardiac auscultation during internal medicine and cardiology training. A nationwide survey. Ann Intern Med. 1993;119:47–54.

    PubMed  CAS  Google Scholar 

  15. Gordon MS, Ewy GA, Felner JM, et al. Teaching bedside cardiologic examination skills using “Harvey,” the cardiology patient simulator. Med Clin North Am. 1980;64:305–13.

    PubMed  CAS  Google Scholar 

  16. Gordon MS, Ewy GA, Felner JM, et al. A cardiology patient simulator for continuing education of family physicians. J Fam Pract. 1981;13:353–6.

    PubMed  CAS  Google Scholar 

  17. Ewy GA, Felner JM, Juul D, et al. Test of a cardiology patient simulator with students in fourth-year electives. J Med Educ. 1987;62:738–43.

    PubMed  CAS  Google Scholar 

  18. Oddone EZ, Waugh RA, Samsa GP, Corey R, Feussner JR. Teaching cardiovascular examination skills: results from a randomized controlled trial. Am J Med. 1993;95:389–96.

    Article  PubMed  CAS  Google Scholar 

  19. Sapira JD. The Art and Science of Bedside Diagnosis. Baltimore: Williams & Wilkins, 1990.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. the Center for Health Services Research in Primary Care, Duke University, Durham, North Carolina

    Eric C. Westman MD, David B. Matchar MD, Gregory P. Samsa PhD &  John R. Feussner MD

  2. Durham Veterans Affairs Medical Center, Duke University, Durham, North Carolina

    Eric C. Westman MD, David B. Matchar MD, Gregory P. Samsa PhD &  John R. Feussner MD

  3. the Division of General Medicine, Duke University, Durham, North Carolina

    Eric C. Westman MD, David B. Matchar MD, Gregory P. Samsa PhD &  John R. Feussner MD

  4. the Center for Health Policy Research and Education, Duke University, Durham, North Carolina

    David B. Matchar MD

  5. the Division of Cardiology, Duke University, Durham, North Carolina

    R. A. Waugh MD

  6. the Division of General Medicine, Audie L. Murphy Memorial Veterans Hospital, San Antonio, Texas

    Cynthia D. Mulrow MD

Authors
  1. Eric C. Westman MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David B. Matchar MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gregory P. Samsa PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Cynthia D. Mulrow MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. R. A. Waugh MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. John R. Feussner MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Westman, E.C., Matchar, D.B., Samsa, G.P. et al. Accuracy and reliability of apical S3 gallop detection. J Gen Intern Med 10, 455–457 (1995). https://doi.org/10.1007/BF02599919

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02599919

Key words

Search

Navigation