The effect of treatment on the presence of abnormal heart sounds in emergency department patients with heart failure

Objective We sought to assess the proportion of ED patients with an electronically detected S3 or S4, determine the relation of these heart sounds to heart failure (HF), and analyze how the proportion changes with ED treatment. Methods Heart sounds were assessed in ED patients with suspected HF. The presence or absence of HF and whether treatment with diuretics or vasodilators had occurred were recorded. Results Three hundred seventy-six patients had complete data. The proportion of patients with an S3 and an S4 was significantly higher for those with HF compared with those without (P < .001). Of 59 patients with HF evaluated before treatment, 57.6% had an S3 and 35.6% had an S4. For the 35 patients with HF evaluated after treatment, the proportions of both S3 and S4 were lower (28.6% and 8.6%, respectively; P ≤ .0064). Conclusions This study suggests the proportion of patients with an electronically detected S3 in HF is more than 50%, and that its presence is affected by prior treatment with diuretics or vasodilators.