RT Journal
A1 KESSLER KM
T1 HEart failure secondary to diastolic dysfunction-reply
JF Archives of Internal Medicine
JO Archives of Internal Medicine
YR 1989
FD July 1
VO 149
IS 7
SP 1695
OP 1695
DO 10.1001/archinte.1989.00390070193037
UL http://dx.doi.org/10.1001/archinte.1989.00390070193037
AB In Reply.—I would agree with Dr Murphy that an S3 gallop and pulsus alternans are more specific to the heart and heart failure than, perhaps, dyspnea or edema. However, a third heart sound may be a physiologic finding in a child; a normal variant in a pregnant woman; a finding compatible with significant mitral regurgitation even without heart failure; or a finding of left ventricular dysfunction, with or without heart failure. Although a pulsus alternans may be seen with advanced myopathic conditions accompanied by congestive heart failure, it can also be seen with aortic stenosis without heart failure, as well as be produced under high afterload-low preload conditions. Therefore, despite the "traditional teachings of physical diagnosis," an S3 gallop and a pulsus alternans have never been, and thus, cannot remain "specific signs of heart failure."