Which physical examination finding is highly specific (about 99 % specificity) for acute decompensated heart failure because it reflects rapid ventricular filling due to volume overload?
Crackles at the lung bases
Third heart sound (S3)
Peripheral pitting edema
Jugular venous distension
The third heart sound (S3) occurs in early diastole when a large volume of blood enters a dilated, compliant ventricle. Although its sensitivity is low (detected in a minority of patients), its presence is one of the most specific bedside indicators of acute heart failure, far exceeding the specificity of crackles, peripheral edema, or jugular venous distension. The other findings listed are either less specific or signify different pathologies.
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