When examining an elderly patient, which finding should be reported immediately to the patient's primary care provider?
a. pulse of 62 beats/minute, regular
b. blood pressure of 120/82
c. capillary refill of less than 3 seconds
d. detection of an S3
D
An S3 heart sound can be normal (physiological) or abnormal (pathological). The physiological S3 is heard in children and young adults. After the age of 30, a physiological S3 is very infrequent. An S3 can also be normal in high-output states such as the third trimester of pregnancy. In adults, the S3 is usually abnormal and may be one of the earliest clinical findings of cardiac dysfunction. The pathological S3 is also called ventricular gallop or an S3 gallop, and it persists when sitting up. The S3 indicates decreased compliance of the ventricles, as in heart failure. A loud, persistent S3 can be an ominous sign. The average life expectancy after a persistent S3 sound is detected is approximately 4 to 5 years. Therefore, this finding should be reported immediately to the patient's primary care provider. All of the clinical findings in options "a," "b," and "c" are normal.
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