S4 Heart Sound

Aka: S4 Heart Sound, S4 Gallop, S4 Gallup Rhythm, Fourth Heart Sound

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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
    1. Athletes
    2. Elderly
  2. Stiff Left Ventricle
    1. Hypertension
    2. Diastolic Dysfunction
    3. Coronary Artery Disease
    4. Aortic Stenosis
    5. Hypertrophic Cardiomyopathy
    6. Ventricular Hypertrophy
    7. Mitral Regurgitation
    8. Pulmonary Hypertension

V. Resources

  1. Williams in Walker (1990) The Fourth Heart Sound, Clinical Methods, 3rd ed
    1. https://www.ncbi.nlm.nih.gov/books/NBK344/
  2. University of Michigan Heart Sound and Murmur Library
    1. http://www.med.umich.edu/lrc/psb/heartsounds/

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