Fourth Heart Sound Gallop 675
Virtual Auscultation
The patient's position is supine.
Lesson
In the recording, note that the fourth heart sound (S4) occurs in late diastole just before S1. The S1 intensity is decreased, while S2 intensity is increased. The fourth heart sound is low-pitched. Use the stethoscope bell, pressing lightly on the chest wall.
The fourth heart sound is generated by increased left ventricle stiffness due to scar tissue formation. This condition could be due to coronary heart disease.
Essential hypertension and aortic stenosis can also lead to fourth heart sounds. The anatomy animation video provides an example of S4.
Waveform
Heart Sounds Video
Authors and Sources
Authors and Reviewers
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Heart sounds by Dr. Jonathan Keroes, MD and David Lieberman, Developer, Virtual Cardiac Patient.
- Lung sounds by Diane Wrigley, PA
- Respiratory cases: William French
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David Lieberman, Audio Engineering
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Heart sounds mentorship by W. Proctor Harvey, MD
- Special thanks for the medical mentorship of Dr. Raymond Murphy
- Reviewed by Dr. Barbara Erickson, PhD, RN, CCRN.
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Last Update: 12/11/2022
Sources
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Heart and Lung Sounds Reference Library
Diane S. Wrigley
Publisher: PESI -
Impact Patient Care: Key Physical Assessment Strategies and the Underlying Pathophysiology
Diane S Wrigley & Rosale Lobo - Practical Clinical Skills: Lung Sounds
- Essential Lung Sounds
Diane S. Wrigley, PA-C
Published by MedEdu LLC - PESI Faculty - Diane S Wrigley
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Case Profiles in Respiratory Care 3rd Ed, 2019
William A.French
Published by Delmar Cengage - Essential Lung Sounds
by William A. French
Published by Cengage Learning, 2011 - Understanding Lung Sounds
Steven Lehrer, MD
- Clinical Heart Disease
W Proctor Harvey, MD
Clinical Heart Disease
Laennec Publishing; 1st edition (January 1, 2009)
