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
S1+S2+S3/S4

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.

Achronym

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