The Third Heart Sound after Exercise in Athletes: An Exploratory Study

10.4077/CJP.2011.AMM049

Li-Sha Zhong；Xing-Ming Guo；Shou-Zhong Xiao；Dong Wang；Wen-Zhu Wu

third heart sound ； heart burden ； cardiac fatigue ； exercise testing ； phonocardiogram

The Chinese Journal of Physiology

54卷4期（2011 / 08 / 01）

219 - 224

英文

The purpose of our study was to investigate the frequency of the third heart sound (S3) of athletes after exercise, and to determine whether the frequency and amplitude of S3 were related to cardiac function. The phonocardiogram exercise test (PCGET) was used in this study, and healthy volunteers consisting of 84 athletes (age 21.0±1.7 years; 62 males and 22 females) and 45 non-athletes (age 24.1±2.0 years; 33 males and 12 females) were enrolled. All subjects were healthy except one with a cardiac murmur without known cause. Immediately after exercise, S3 occurred in 21 athletes (25.0%) and 10 non-athletes (22.2%) during PCGET. There were very significant differences between pre-exercise and post-exercise in the frequency of S3 (P＜0.01), and no significant difference between athletes and nonathletes (P＞0.05). The prevalence of S3/S2≥1 was significantly (P＜0.05) higher for the athlete group (47.1%) as compared to the non-athlete group (10%). Those results indicated that the emergence of S3 was an indicator of heart burden, and S3 after exercise in the athlete group was physiological. Our study showed that the amplitude of S3 had a very sensitive response to cardiac function reduction and S3/S2≥1 could eventually be used to assess cardiac fatigue states.

1. Abdulla, A. M.,Frank, M. J.,Erdin, R. A.,Canedo, M. I.(1981).Clinical significance and hemodynamic correlates of the third heart sound gallop in aortic regurgitation. A guide to optimal timing of cardiac catheterization.Circulation,64,464-471.
2. Aronow, W. S.,Uyeyama, R. R.,Cassidy, J.,Nebolon, J.(1971).Resting and postexercise phonocardiogram and electrocardiogram in patients with angina pectoris and in normal subjects.Circulation,43,273-277.
3. Bonow, R. O.,Dodd, J. T.,Maron, B. J.,O''Gara, P. T.,White, G. G.,Mclntosh, C. L.(1988).Long-term serial changes in left ventricular function, and reversal of ventricular dilatation after valve replacement or chronic aortic regurgitation.Circulation,78,1108-1120.
4. Braunwald, E.,Morror, A. G.(1958).Origin of heart sounds as estimated by analysis of the sequence of cardiodynamic work.Circulation,18,971-974.
5. Breuer, H. W.(1981).Auscultation of the heart in pregnancy.Munchen. Med. Wochensch,123,1705-1707.
6. Cohn, P. F.,Thompson, P.,Strauss, W.,Todd, J.,Gorlin, R.(1973).Diastolic heart sounds during static (handgrip) exercise in patients with chest pain.Circulation,47,1217-1221.
7. Craige, E.(1976).On the genesis of heart sounds-Contributions made by echocardiographic studies.Circulation,53,207-209.
8. Douglas, P. S.,O''Toole, M. L.,Hiller, W. D.,Hackney, K.,Reichek, N.(1987).Cardiac fatigue after prolonged exercise.Circulation,76,1206-1213.
9. Drzewiecki, G. M.,Wasicko, M. J.,Li, J. K.(1991).Diastolic mechanics and the origin of the third heart sound.Ann. Biomed. Eng.,19,651- 667.
10. Fry, R. W.,Morton, A. R.(1991).Overtraining in athletes: an update.Sports Med.,12,32-65.
11. Fry, R. W.,Morton, A. R.,Garcia-Webb, P.,Crawford, G. P. M.,Keast, D.(1992).Biological responses to overload training in endurance sports.Eur. J. App. Physiol.,64,335-344.
12. Gould, L.,Umali, F.,Gomprecht, R. F.(1972).The presystolic gallop in acute myocardial infarction.Angiology,23,549-553.
13. Hammermeister, K. E.,Fisher, L.,Kennedy, W.,Samuels, S.,Dodge, H. T.(1978).Prediction of late survival in patients with mitral valve disease from clinical, hemodynamic, and quantitative angiographic variables.Circulation,57,341-349.
14. Hill, J. C.,O''Rourke, R. A.,Lewis, R. P.,McGranahan, G. M.(1969).The diagnostic value of the atrial gallop in acute myocardial infarction.Am. Heart J.,78,194-201.
15. Kentta, G.,Hassmén, P.,Raglin, J. S.(2001).Training practices and overtraining syndrome in Swedish age-group athletes.Int. J. Sports Med.,22,460-465.
16. Kono, T.,Rosman, H.,Alam, M.,Stein, P. D.,Sabbah, H. N.(1993).Hemodynamic correlates of the third heart sound during the evolution of chronic heart failure.J. Am. Coll. Cardiol.,21,419-423.
17. Kuipers, H.,Keizer, H. A.(1988).Overtraining in elite athletes: review and future directions.Sports Med.,6,79-92.
18. Lee, E.,Michaels, A.,Selvester, R.,Drew, B.(2009).Frequency of diastolic third and fourth heart sounds with myocardal ischemia induced during percutaneous coronary intervention.J. Electrocardiol,42,39-45.
19. Levin, S.(1991).Overtraining causes olympic-sized problems.Physician. Sports Med.,19,112-118.
20. McNair, J. D.(1967).The pathologic third heart sound in angina pectoris.Cardiologia,51,79-91.
21. Nirav, J. M.,Ijaz, A. K.(2004).Third heart sound: genesis and clinical importance.Int. J. Cardiol.,97,183-186.
22. Nixon, P. G. F.(1963).The genesis of the third heart sound.Am. Heart J.,65,712-714.
23. Nuno, M.,Richard, J. W.(2007).Trainability of young athletes and overtraining.J. Sport Sci. Med.,6,353-367.
24. Patel, R.,Bushnell, D. L.,Sobotka, P. A.(1993).Implications of an audible third heart sound in evaluating cardiac function.Western J. Med.,158,606-609.
25. Sakamoto, T.,Ichiyasu, H.,Hayashi, T.,Kawaratani, H.,Amano, K.(1976).Genesis of the third heart sound phonoechocardiographic studies.Jpn. Heart J.,17,150-162.
26. Sawayama, T.,Niki, I.,Matsuura, T.,Ichinose, S.(1966).Exercise phonocardiogram: significance of the third and atrial sounds.Jpn. Circulation J.,30,1153-1159.
27. Shah, P. M.,Gramiak, R.,Kramer, D. H.,Yu, P. N.(1968).Determinants of atrial (S4) and ventricular (S3) gallop sounds in primary myocardial disease.New. Engl. J. Med.,278,753-758.
28. Shah, S. J.,Marcus, G. M.,Gerber, I. L.,Mckeown, B. H.,Vessey, J. C.,Jordan, M. V.,Huddleston, M.,Foster, E.,Chatterjee, K,Michaels, A. D.(2008).Physiology of the third heart sound: novel insights from tissue doppler imaging.Am. Soc. Echocardiogr.,21,394-400.
29. Stock, E.(1966).Auscultation and phonocardiography in acute myocardialinfarction.Med. J. Australia,1,1060-1062.
30. Tavel, M. E.(1996).The appearance of gallop rhythm after exercise stress testing.Clin. Cardiol,19,887-891.
31. Tribouilloy, C. M.,Enriquez-Sarano, M.,Mohty, D.,Horn, R. A.,Bailey, K. R.,Seward, J. B.,Weissler, A. M.,Tajik, A. J.(2001).Pathophysiologic determinants of third heart sounds: a prospective clinical and Doppler echocardiographic study.Am. J. Med.,111,96-102.
32. Wilbert, S.,Aronow, J. C.(1975).Five-year follow-up of resting and postexercise phonocardiogram in asymptomatic persons.Cardiology,60,247-250.
33. Wu, W. Z.,Guo, X. M.,Xie M. L.,Xiao, S. Z.,Yang, Y.,Xiao, Z. F.(2009).Research on first heart sound and second heart sound amplitude variability and reversal phenomenon-A new finding in athletic heart study.J. Med. Biol. Eng.,29,202-205.
34. Xiao, S. Z.,Guo, X. M.,Sun, X. B.,Xiao, Z. F.(2002).A relative value method for measuring and evaluating cardiac reserve.Biomed. Eng. Online,6,1-6.
35. Xiao, S. Z.,Guo, X. M.,Wang, F. L.,Xiao, Z. F.,Liu, G. C.,Zhan, Z. F.,Sun, X. B.(2003).Evaluating two new indicators of cardiac reserve.IEEE. Eng. Med. Biol. Mag.,22,147-152.
36. Xiao, S. Z.,Wang, Z. G.,Hu, D. Y.(2002).Studying cardiac contractility change trend to evaluate cardiac reserve.IEEE. Eng. Med. Bio. Mag.,21,74-76.
37. Xiao, Y. H.,Xiao, S. Z.,Cao, Z. H.,Zhou, S. Y.,Pei, J. H.(1999).The phonocardiogram exercise test.IEEE. Eng. Med. Bio.,18,111-115.