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/

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