Background The third heart sound (S3) is known as a very specific clinical sign for heart failure and is associated with worse clinical outcomes. In the context of heart failure (HF) the presence of a pronounced or audible S3 is a specific sign of elevated filling pressures and is suggestive of a restrictive filling pattern with a steep transmitral E‐wave. Recent work has demonstrated that implantable device-based S3 measurements in the inaudible range, in implantable devices, may be even more predictive of clinical outcomes. Methods Using the Nanowear wearable diagnostic device containing a directional microelectronic machine microphone and electrocardiogram (ECG) capability, we report a system that can effectively detect heart sounds. Results Heart sounds and ECG were measured in a 74-year-old female with Heart Failure with Preserved Ejection Fraction admitted for acute on chronic heart failure exacerbation. S3 was isolated using a search window using ECG tracing for identification of S1 and S2 (Figure 1A). Ensemble heart sounds were plotted and root mean square (RMS) mean, in mVolts (mV), were calculated for S3 in sitting (63 mV), supine (250.5 mV) and right lateral decubitus (135.2 mV) positions (Figure 1B, C). Conclusion We report an accurate method, using the Nanowear device, to electronically measure heart sounds that is positionally sensitive. Invasively-measured S3 heart sounds correlate with clinical outcomes, however their utility is limited to patients with implantable cardioverter defibrillator or cardiac resynchronization therapy devices. Future studies may validate non-invasive remote monitoring of S3 heart sounds as a management tool for heart failure patients.