II. Pathophysiology

  1. S4 represents rapid active ventricular filling
    1. Occurs as atria contract during late diastole
  2. Outside of normal causes (see below), typically represents a stiff ventricle that resists dilation
    1. Associated with Ventricular Hypertrophy and Diastolic Dysfunction

III. Signs

  1. S4, S1, S2 Sound like "Ten-ne-see" (dub-lub-dub)

IV. Causes

  1. Normal in athletes and the elderly
  2. Stiff Left Ventricle
    1. Hypertension
    2. Diastolic Dysfunction
    3. Coronary Artery Disease
    4. Aortic Stenosis
    5. Cardiomyopathy
    6. Ventricular Hypertrophy

V. Resources

  1. University of Michigan Heart Sound and Murmur Library
    1. http://www.med.umich.edu/lrc/psb/heartsounds/

Images: Related links to external sites (from Bing)

Related Studies

Ontology: Atrial sound (C0232240)

Concepts Finding (T033)
SnomedCT 48038003, 277454003
LNC LA18245-3
English Fourth heart sound, S4 (function), Fourth heart sound, S4, function (observable entity), Fourth heart sound, S4, Fourth heart sound, S<sub>4</sub> (function), Fourth heart sound, S<sub>4</sub>, function (observable entity), Fourth heart sound, S<sub>4</sub>, Fourth heart sound, S4, function, Fourth heart sound, S>4<, function, Fourth heart sound, S<sub>4</sub>, function, Fourth heart sound, S<sub>4</sub>, NOS, Fourth heart sound, S>4<, NOS, Fourth heart sound, S4, NOS, S4 heart sound (physical finding), fourth heart sound, heart sounds S4, S4 heart sound, heart sound s4, s4 heart sound, heart s4 sounds, Fourth cardiac sound, S4, Atrial sound, Fourth heart sound, S>4<, function (observable entity), Fourth heart sound, S>4<, Atrial sound (finding), Fourth heart sound, S>4< (function)
Dutch vierde harttoon
French Quatrième bruit du coeur
German vierter Herzton
Italian Quarto tono cardiaco
Portuguese 4º som cardíaco
Spanish Cuarto ruido cardiaco, cuarto ruido cardíaco, R<sub>4</sub>, cuarto ruido cardíaco, R4 (función), cuarto ruido cardíaco, R4, cuarto ruido cardíaco, R<sub>4</sub> (función), cuarto ruido cardíaco, R4 (entidad observable), cuarto ruido cardíaco, R<sub>4</sub> (entidad observable), cuarto ruido cardíaco, R>4< (entidad observable), cuarto ruido cardíaco, R>4< (función), cuarto ruido cardíaco, R>4<, ruido auricular (hallazgo), ruido auricular
Japanese 第4音, ダイ4オン
Czech Čtvrtá srdeční ozva
Hungarian Negyedik szívhang