The presence ofgrunting, crackles, retractions, and anS3 gallop—withhypotension and tachycardia—is highly suggestive ofcardiogenic shock. These findings indicatepoor myocardial contractility and pulmonary congestion. An S3 gallop is particularly indicative ofvolume overloadin the setting of ventricular dysfunction.

“Cardiogenic shock should be suspected in pediatric patients with signs of respiratory distress (crackles, retractions), an S3 gallop, and poor perfusion. Myocardial failure leads to elevated filling pressures and pulmonary edema.”

(Referenced from CCRN Pediatric – Direct Care: Cardiovascular, Types of Shock and Hemodynamic Findings)