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fourth heart sound (S4)
Etiology:
- aortic stenosis
- hypertension
- hypertrophic cardiomyopathy
- cardiac ischemia (the ischemic ventricle may have reduced compliance)
- pulmonary hypertension (S4 gallop)*
* right-sided gallops best heard with the patient supine
* left-sided gallops best heard with patient in left lateral decubitus position
Epidemiology:
- S4 is more prevalent in elderly >= 75 years than in younger patients [3]
Pathology:
- reflects left atrial contraction into a noncompliant left ventricle
Clinical manifestations:
- low-pitched sound preceding S1
- heard best with the bell of the stethoscope at the apex of the heart
Management:
- no additional testing needed in asymptomatic hypertensive patients.
General
abnormal heart sound
References
- Harrison's Principles of Internal Medicine, 13th ed.
Companion Handbook, Isselbacher et al (eds), McGraw-Hill
Inc. NY, 1995, pg 327
- Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed)
Lippincott-Raven, Philadelphia, 1998, pg 38
- Kitzman DW, Upadhya B, Taffet GE.
Effects of aging on cardiovasculare structure and function:
In: Ouslander JG, Studenski S et al eds
Hazzard's Geriatric Medicine and Gerontology, 7th ed. McGraw Hill;2017:1129-1144