Picking up such low-pitched heart sounds as S3 and S4 can be difficult. To clarify what you are hearing, convert the bell of your stethoscope into a diaphragm by pressing down. If the sound disappears, it is most likely an S3 or S4. — Ziemowit Mazur, PA-C, North Chicago, Ill.
These are letters from practitioners around the country who want to share their clinical problems and successes, observations and pearls with their colleagues. We invite you to participate. If you have a clinical pearl, submit it here.
