Signs
 

Fourth Heart Sound

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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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