S3 and S4 are low-frequency diastolic sounds that originate in the ventricles. The S3 sound is indicative of enhanced volume of blood within the ventricle. An S3 is in a position to be distinguished as either left- or appropriate-sided by whether or not or not it increases in intensity with inhalation or exhalation. A right-sided S3 will raise upon inhalation, and a left-sided S3 will increase with exhalation. There are two regular heart sounds, labeled S1 and S2, and additional heart sounds labeled S3 and S4. The clichéd “Lub-Dub” of the heartbeat heard by way of a stethoscope minimizes and understates the complexity of what truly is occurring.
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