An adult with coronary artery disease presents with increasing shortness of breath. Which finding is most likely associated with their condition?

In the context of an adult with coronary artery disease (CAD) experiencing increasing shortness of breath, the presence of a third heart sound (S3) is most indicative of heart failure or volume overload, which can occur in patients with advanced CAD. The S3 heart sound, often referred to as a "gallop," is associated with the rapid filling of the ventricles during early diastole. This finding can indicate a decreased left ventricular compliance or volume overload, which is commonly seen in heart failure due to ischemic heart disease.

Coronary artery disease can lead to reduced coronary blood flow and myocardial ischemia, contributing to heart dysfunction. As the heart struggles to maintain adequate circulation, fluid can back up into the lungs, leading to pulmonary congestion and the patient’s reported shortness of breath. The presence of the third heart sound, therefore, can signify that the heart is not efficiently managing the blood volume, which is particularly relevant in the context of heart failure related to CAD.

On the other hand, while diastolic murmurs, systolic ejection murmurs, and pericardial friction rubs can be relevant findings in various cardiac conditions, they are less directly associated with the signs of volume overload and heart failure