Dec 06, · When both S 3 and S 4 are heard this is called a summation gallop and suggests advanced disease (Januzzi et al., ). Commonly heard murmurs in patients with heart failure include a holosystolic murmur of mitral regurgitation heard at the apex and radiating to axilla, tricuspid regurgitation murmur, and aortic stenosis (Januzzi et al., ). Normal heart sounds included for . Jul 04, · Systolic congestive heart failure occurs when the heart does not pump blood effectively. It may happen when the heart muscle is too weak or when another health problem prevents it .