Journal of General Internal Medicine

, Volume 10, Issue 8, pp 455–457 | Cite as

Accuracy and reliability of apical S3 gallop detection

  • Eric C. Westman
  • David B. Matchar
  • Gregory P. Samsa
  • Cynthia D. Mulrow
  • R. A. Waugh
  • John R. Feussner
Brief Reports


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.

Key words

physical examination heart likelihood ratio sensitivity specificity physicians apical S3 gallop 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 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.PubMedGoogle Scholar
  2. 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.PubMedCrossRefGoogle Scholar
  3. 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.PubMedCrossRefGoogle Scholar
  4. 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.PubMedCrossRefGoogle Scholar
  5. 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.PubMedCrossRefGoogle Scholar
  6. 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.PubMedCrossRefGoogle Scholar
  7. 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.PubMedCrossRefGoogle Scholar
  8. 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.PubMedCrossRefGoogle Scholar
  9. 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. 10.
    Raftery EB, Holland WW. Examination of the heart: an investigation into variation. Am J Epidemiol. 1987;85:438–44.Google Scholar
  11. 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.PubMedCrossRefGoogle Scholar
  12. 12.
    Sloan AW, Campbell FW. Henderson AS. Incidence of the physiological third heart sound. Br Med J. 1952;2:853–5.PubMedCrossRefGoogle Scholar
  13. 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.PubMedGoogle Scholar
  14. 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.PubMedGoogle Scholar
  15. 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.PubMedGoogle Scholar
  16. 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.PubMedGoogle Scholar
  17. 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.PubMedGoogle Scholar
  18. 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.PubMedCrossRefGoogle Scholar
  19. 19.
    Sapira JD. The Art and Science of Bedside Diagnosis. Baltimore: Williams & Wilkins, 1990.Google Scholar

Copyright information

© Society of General Internal Medicine 1995

Authors and Affiliations

  • Eric C. Westman
    • 1
    • 2
    • 3
  • David B. Matchar
    • 1
    • 2
    • 3
    • 4
  • Gregory P. Samsa
    • 1
    • 2
    • 3
  • Cynthia D. Mulrow
    • 6
  • R. A. Waugh
    • 5
  • John R. Feussner
    • 1
    • 2
    • 3
  1. 1.the Center for Health Services Research in Primary CareDuke UniversityDurham
  2. 2.Durham Veterans Affairs Medical CenterDuke UniversityDurham
  3. 3.the Division of General MedicineDuke UniversityDurham
  4. 4.the Center for Health Policy Research and EducationDuke UniversityDurham
  5. 5.the Division of CardiologyDuke UniversityDurham
  6. 6.the Division of General MedicineAudie L. Murphy Memorial Veterans HospitalSan Antonio

Personalised recommendations