S4 Heart Sound


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

  • 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
  • Signs
  1. S4, S1, S2 Sound like "Ten-ne-see" (dub-lub-dub)
  • 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
  • Resources
  1. University of Michigan Heart Sound and Murmur Library
    1. http://www.med.umich.edu/lrc/psb/heartsounds/