On the third day after an acute MI, auscultation reveals bilateral crackles up to the mid-scapular level and a new S3 gallop. There is no hypotension and no peripheral hypoperfusion. According to the Killip classification, this patient belongs to which class?
- A Killip class I
- B Killip class II
- C Killip class III ✓
- D Killip class IV
Correct answer: C. Killip class III
Explanation
Killip class I means no clinical evidence of heart failure; class II includes rales, an S3 gallop or elevated jugular venous pressure indicating mild to moderate left ventricular failure; class III denotes frank pulmonary edema with rales extending beyond the lower third of the lung fields; class IV is cardiogenic shock with hypotension and hypoperfusion. This patient has extensive bilateral rales with an S3 but preserved perfusion, placing him in class III, which carries substantially higher short-term mortality than class II.
Reference: Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 11th ed.
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Written and medically reviewed by the StethoPrep medical team.