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Causes of fourth heartsound

 LV S4  causes

  1. Systemic hypertension
  2. AS (left ventricular hypertrophy)
  3. LV myocardial infarction
RVS4  causes
  1. Pulmonary hypertension
  2. Pulmonary stenosis (Right Ventricular hypertrophy)
  3. RV myocardial infarction.
Features of RVS4
  1. Heard at LLSB
  2. Inspiratory augmentation present
  3. Associated with  a wave in JVP
  4. Seen in PAH and pulmonary stenosis
Triple rhythm

Quadruple rhythm
S1,S2 + S3 + S4.

Seen In:
  • Cardiomyopathy
  • Coronary artery disease
Summation gallop
S, S3 with merged S, & S4.

Causes of pathological S4
  1. Hypertrophic cardiomyopathy
  2. Systemic hypertension
  3. Coronary artery disease
  4. Myocardial infarction
  5. Ventricular aneurysm.
S3 -Ventricular distension sound.
S4 -Atrial contraction sound.

LV : Left Ventricular
AS : Aortic Stenosis
RV : Right Ventricular

S1 - First Heart Sound
S2 - Second Heart Sound
S3 - Third Heart Sound
S4 - Fourth Heart Sound