Summary:

In this otherwise healthy young woman with no associated cardiovascular abnormality, this was considered to be "a physiologic S₃." No further studies were deemed necessary.

Click to review auscultation.

Lessons:

1. With pregnancy the circulation is hyperkinetic and increased plasma volume leads to a lowered hematocrit which reduces the viscosity of the blood.
   
   
2. These factors promote the occurrence of innocent systolic murmurs and physiologic third heart sounds.
   
   
3. PEARL: This S₃ would be inaudible with the diaphragm end-piece.

 

Case 3 is now finished.