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Fourth Heart Sound

April 17th, 2019


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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