The Fourth Heart Sound
July 1st, 2020
Overview
The fourth heart sound (S4) is a pathological finding associated with turbulence during atrial systole.
Interpretation
- Listen for a gallop rhythm with an extra heart sound just before S1. Best heard on inspiration.
Causes of Fourth Heart Sound
- Hypertension
- Aortic stenosis
- Pulmonary stenosis
- Mitral regurgitation
- Hypertrophic cardiomyopathy
- Acute myocardial infarction
Gallop rhythms are so named due to the similarity of their cadence with that of the sound of a horse galloping.
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