Fourth heart sound
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). It occurs just after atrial contraction and immediately before the systolic S1 and is caused by the atria contracting forcefully in an effort to overcome an abnormally stiff or hypertrophic ventricle.
| Fourth heart sound | |
|---|---|
| Other names | Atrial gallop, presystolic gallop |
| Diagram of the heart. | |
| Specialty | Cardiology |
This produces a rhythm classically compared to the cadence of the word "Tennessee." One can also use the phrase "A-stiff-wall" to help with the cadence (a S4, stiff S1, wall S2), as well as the pathology of the S4 sound.
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