Fourth heart sound - Wikipedia

The fourth heart sound or S4 is an extra heart sound that occurs during late diastole, immediately before the normal two "lub-dub" heart sounds (S1 and S2). Fourthheartsound FromWikipedia,thefreeencyclopedia Jumptonavigation Jumptosearch MedicalconditionFourthheartsoundOthernamesAtrialgallop,presystolicgallopDiagramoftheheart.SpecialtyCardiology ThefourthheartsoundorS4isanextraheartsoundthatoccursduringlatediastole,immediatelybeforethenormaltwo"lub-dub"heartsounds(S1andS2).ItoccursjustafteratrialcontractionandimmediatelybeforethesystolicS1andiscausedbytheatriacontractingforcefullyinanefforttoovercomeanabnormallystifforhypertrophicventricle. Thisproducesarhythmclassicallycomparedtothecadenceoftheword"Tennessee."[1][fullcitationneeded][2]Onecanalsousethephrase"A-stiff-wall"tohelpwiththecadence(aS4,stiffS1,wallS2),aswellasthepathologyoftheS4sound.[3] Contents 1Physiology 2Treatment 3References 4Externallinks Physiology[edit] Thenormalheartsounds,S1andS2,areproducedduringtheclosingoftheatrioventricularvalvesandsemilunarvalves,respectively.Theclosingofthesevalvesproducesabriefperiodofturbulentflow,whichproducessound. TheS4soundoccurs,bydefinition,immediatelybeforeS1,whiletheatriaoftheheartarevigorouslycontracting.[4]Itismanifestasavibrationof20to30 Hzwithintheventricle.[4]Whilethemechanismisnotabsolutelycertain,itisgenerallyacceptedthatS4iscausedbystiffeningofthewallsoftheventricles(usuallytheleft),whichproducesabnormallyturbulentflowastheatriacontracttoforcebloodintotheventricle.[4] S4issometimesaudibleintheelderlyduetoamorerigidventricle.Whenloud,itisasignofapathologicstate,[5]usuallyafailingleftventricle.Iftheproblemlieswiththeleftventricle,thegalloprhythmwillbeheardbestatthecardiacapex.Itwillbecomemoreapparentwithexercise,withthepatientlyingontheleft-handside,orwiththepatientholdingexpiration.Iftheproblemisintherightventricle,theabnormalsoundwillbemostevidentonthelowerlefthandsideofthesternumandwillgetlouderwithexerciseandquick,deepinspiration.[6] S4hasalsobeentermedanatrialgalloporapresystolicgallopbecauseofitsoccurrencelateintheheartcycle.Itisatypeofgalloprhythmbyvirtueofhavinganextrasound;theothergalloprhythmiscalledS3.Thetwoarequitedifferent,buttheymaysometimesoccurtogetherformingaquadruplegallop.Iftheheartrateisalsoveryfast(tachycardia),itcanbecomedifficulttodistinguishbetweenS3andS4thusproducingasinglesoundcalledasummationgallop. Treatment[edit] TheS4heartsounditselfdoesnotrequiretreatment;ratherplansshouldbelaidtostoptheprogressionofwhatevercausestheunderlyingventriculardysfunction.TheS4heartsoundisasecondarymanifestationofaprimarydiseaseprocessandtreatmentshouldbefocusedontreatingtheunderlying,primarydisease. References[edit] ^clinicalexaminationAsystemicguidetophysicaldiagnosis ^"Techniques-HeartSounds&MurmursExam-PhysicalDiagnosisSkills-UniversityofWashingtonSchoolofMedicine".depts.washington.edu. ^"TheFourthHeartSound".TheAuscultationAssistant-RubsandGallops. ^abcWilliams,EricS.(December2,1990)."TheFourthHeartSound".Butterworths.PMID 21250185–viawww.ncbi.nlm.nih.gov. ^"THEPHONOCARDIOGRAPHY".Retrieved2009-03-06. ^TavelME(Nov1996)."Theappearanceofgalloprhythmafterexercisestresstesting".ClinCardiol.19(11):887–91.doi:10.1002/clc.4960191109.PMID 8914783. Externallinks[edit] ClassificationDICD-9-CM:427.9,785.3DiseasesDB:4938 KUOPT,SCHNABELTG,BLAKEMOREWS,WHEREATAF(1957)."Diastolicgallopsounds,themechanismofproduction".J.Clin.Invest.36(7):1035–42.doi:10.1172/JCI103499.PMC 1072690.PMID 13449156. vteSignsandsymptomsrelatingtothecirculatorysystemChestpain Referredpain Angina Levine'ssign Auscultation Heartsounds SplitS2 S3 S4 Galloprhythm Heartmurmur Systolic Functionalmurmur Still'smurmur Diastolic Pulmonaryinsufficiency GrahamSteellmurmur Continuous CareyCoombsmurmur Mitralinsufficiency Presystolicmurmur Pericardialfrictionrub Heartclick Bruit carotid Pulse Tachycardia Bradycardia Pulsusparadoxus doubled Pulsusbisferiens Pulsusbigeminus Pulsusalternans Other Palpitations Apexbeat Cœurensabot Jugularvenouspressure CannonAwaves Hyperaemia Shock Cardiogenic Obstructive Hypovolemic Distributive SeefurtherTemplate:Shock CardiovasculardiseaseAorticinsufficiency Collapsingpulse DeMusset'ssign Duroziez'ssign Müller'ssign AustinFlintmurmur Mayne'ssign Otherendocardium endocarditis:Roth'sspot Janewaylesion/Osler'snode Bracht–Wachterbodies Pericardium Cardiactamponade/Pericardialeffusion:Beck'striad Ewart'ssign Other rheumaticfever: Anitschkowcell Aschoffbody EKG Jwave Gallavardinphenomenon VasculardiseaseArterial aorticaneurysm Cardarelli'ssign Oliver'ssign pulmonaryembolism Rightheartstrain radialarterysufficiency Allen'stest pseudohypertension thrombus LinesofZahn Adson'ssign arteriovenousfistula Nicoladoni–Branhamsign Venous Friedreich'ssign Caputmedusae Kussmaul'ssign Trendelenburgtest superiorvenacavasyndrome Pemberton'ssign Retrievedfrom"https://en.wikipedia.org/w/index.php?title=Fourth_heart_sound&oldid=997403367" Categories:CardiologyHiddencategories:ArticleswithshortdescriptionShortdescriptionisdifferentfromWikidataAllarticleswithincompletecitationsArticleswithincompletecitationsfromDecember2020 Navigationmenu Personaltools NotloggedinTalkContributionsCreateaccountLogin Namespaces ArticleTalk English Views ReadEditViewhistory More Search Navigation MainpageContentsCurrenteventsRandomarticleAboutWikipediaContactusDonate Contribute HelpLearntoeditCommunityportalRecentchangesUploadfile Tools WhatlinkshereRelatedchangesUploadfileSpecialpagesPermanentlinkPageinformationCitethispageWikidataitem Print/export DownloadasPDFPrintableversion Languages العربيةفارسی中文 Editlinks