s is sometimes audible in the elderly due to a more rigid ventricle. when loud, it is a sign of a pathologic state, usually a failing left ventricle. if the problem lies with the left ventricle, the gallop rhythm will be heard best at the cardiac apex. it will become more apparent with exercise, with the patient lying on the left-hand side, or with the patient holding expiration. if the problem is in the right ventricle, the abnormal sound will be most evident on the lower left hand side of the sternum and will get louder with exercise and quick, deep inspiration.