Q: Why do we use a stethoscope?
A: For many reasons, and here’s one of them that I will argue is undervalued. And is still at the heart (hint hint) of some ongoing research…

First described by Potain in 1880, the gallop rhythm refers to the presence and cadence of abnormal diastolic cardiac sounds, namely S3 and S4.

In 1989, Stevenson and Perloff described the previously unestablished relationship between physical exam signs, increased ventricular filling pressures, and decreased cardiac output in chronic HF patients. Stevenson et al. JAMA. 1989.

An excellent point is made in this paper: “While the relationship between physical signs and hemodynamic profile has a firm basis for acute congestive heart failure, the chronic state is characterized by a host of compensatory mechanisms that may cause disparities, …”

“…such as the absence of rales and peripheral edema despite symptomatic elevation of ventricular filling pressures.”

This cohort had quite the notable med regimen: digoxin (84%), furosemide (84%), vasodilators (56%), and milrinone (4%); 39/50 were being evaluated for transplant