The nurse should anticipate that the client has a heart failure, which causes the shortness of breath, jugular vein distention and fatigue that the client is experiencing. The sound of S3 is lower in pitch than the normal sounds of the heart. The presence of the third heart sound occurs soon after the normal two "lub-dub" heart sounds. This is caused by the oscillation of blood back and forth between the walls of the ventricles originated by the inflow of blood from the atria. Furthermore, S3 may be normal to individual under 40 years of age and to some trained athletes but should vanish before middle age.