The Pathological S3

1. What are the most common associated cardiac findings with a pathological S3?

ANS: A high mean left atrial pressure due to a high V wave, a noncompliant LV, and a large ventricle resulting from a poor ejection fraction.

2. What pathological cardiac condition is generally present when an S3 occurs in the presence of a high left atrial pressure due to a low ejection fraction?

ANS: A cardiomyopathy, most often idiopathic (which is probably viral) or due to extensive ischemic heart disease.

Note: In hypertrophic cardiomyopathies, especially with outflow obstruction, an S3 is common due to profound alteration in LV compliance.

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