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S3 and s4 - heart sounds
Medicine (MD)
University of Northern Philippines
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DOMINGO, JOHN VICKSEN M. DCFM: Group-6, Subgroup 2
The main normal heart sounds are the S1 and the S2 heart sound. The S3 can be normal, at times, but may be pathologic. A S4 heart sound is almost always pathologic. Heart Sounds
S3 S
a.k. “Ventricular Gallop” “Atrial Gallop”
Definition ● After the mitral valve opens, there is a period of rapid ventricular filling as blood flows early in diastole from left atrium to left ventricle. In children and young adults, a third heart sound, S 3 , may arise from rapid deceleration of the column of blood against the ventricular wall. ● In older adults, an S 3 , sometimes termed “an S 3 gallop,” usually indicates a pathologic change in ventricular compliance. ● It is often a sign of systolic failure
● A fourth heart sound, S 4 , marks atrial contraction and is often not found in normal adults. It immediately precedes S 1 of the next beat and can also reflect a pathologic change in ventricular compliance
● It is an important sign of diastolic HF or active ischemia and is rarely a normal finding
Occurrence Occurs just after S2 (early diastole) when the mitral valve opens, allowing passive filling of the left ventricle.
immediately precedes S1 (late diastole) when the atria contract to force blood into the left ventricle
Etiology The S3 sound is actually produced by the large amount of blood striking a very compliant left ventricle.
The fourth heart sound (S 4 ), when audible, is caused by vibration of the ventricular wall during atrial contraction.
This sound is usually associated with a stiffened ventricle (low ventricular compliance)
Sound low pitched sound that is best heard at the apex with the patient in the left lateral decubitus position
Possible Conditions
↑ Ventricular Compliance (overly compliant LV)
Physiologic 🠀children
🠀pregnant
🠀well trained athletes
Pathologic
🠀Congestive Heart Failure
↓Ventricular Compliance (non-compliant LV)
e. 🠀Left Ventricular Hypertrophy
🠀Myocardial ischemia
🠀Older adults
DOMINGO, JOHN VICKSEN M. DCFM: Group-6, Subgroup 2
References:
“Heart Sounds Topic Review | LearntheHeart.” Healio: Medical News, Journals, and Free CME, healio/cardiology/learn-the-heart/cardiology-review/topic-reviews/heart-sounds. Accessed 7 Aug. 2021. Bickley, Lynn S. Bates’ Guide To Physical Examination and History Taking. 12th ed., Lippincott Williams & Wilkins, 2017, p. 348.
S3 and s4 - heart sounds
Course: Medicine (MD)
University: University of Northern Philippines
