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Medicine

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Cardiology

Question
15 out of 19
 

S4 is seen in all of the following, Except: (AIIMS May 2010)



A AS
B Acute MI

C Atrial fibrillation
D HOCM

Ans. C

Atrial fibrillation

S4 (Fourth heart sound)

Also known as presystolic or atrial gallop

1. It is never physiological

2. It is produced by emptying of the atrium into non-compliant ventricle.

3. It is associated with effective atrial contraction and hence absent in patients with atrial fibrillations

4. Causes – Systemic, HTn Q,AS Q,HOCM, CAD, acute MR, delay in Av conduction (Ref. Hari-18th ed., Pg-1826)

(Extra Edge: It is not seen in LV aneurysm)

Extra Edge:

1. Incidence of S4 increase with age

2. Incidence of S3 decrease with age

3. S3, S4 is low pitched sound & heard best with bell of stetho.

4. Summation gallop: The combined presence of S3 and S4 is a quadruple gallop. At rapid heart rates, S3 and S4 may merge to produce a summation gallop.

Cardiology Flashcard List

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