Fourth heart sound (S4)

Hey guys, I’ll be introducing the mechanisms behind the fourth heart sound (S4), including the specific conditions that are required in order for it to be heard clinically. Techniques of auscultating an S4 will be shown in another video. Enjoy!
PDF link of slides: drive.google.com/file/d/11InK...
❓ Active recall questions:
1. Define S4?
2. What is normal LA booster pump?
3. What hemodynamics contribute to production of S4?
4. What are pre-requisites to production of S4?
5. What are causes of LV S4?
6. What causes RVS4?
7. When is S4 audible in patients with acute myocardial infarction?
8. What is significance of S4 in AS?
9. Can S4 be absent in HCM?
10. Does S4 persist when LV dysfunction sets in?
11. What are clinical implications of S4 as compared to S3?
12. Is S4 heard in acute or chronic MR?
About me:
I am Dr. Sonali, an interventional cardiologist from India. I have a special interest in cardiology academics & teaching with an emphasis on building clear concepts with clinical correlation. My channel "Cardiology and Beyond" serves to achieve the same...I hope you find it useful in your clinical practice.
Connect with me:
🐤Twitter: / sonaliinamdar21
📸 Instagram: / sonaliinamdar
📩 Email: [e-mail]
Whiteboard app used: Explain Everything.
References:
1. Clinical Examination in Cardiology, B.N. Vijay Raghawa Rao.
2. Clinical Methods in Cardiology, B Soma Raju.
3. Essentials of Cardiac Physical Diagnosis, Jonathan Abrams.
4. The Art and Science of Cardiac Physical Examination, N Ranganathan, V Sivaciyan, F B Saksena.

[@tonylasala2984]

A extremely well presented analysis of the S4 gallop. Travel’s book on auscultation states the same information as you have presented. I must add, Travel teaches that a normal phonocardiogram with extremely sensitive pickups will register a forth heart sound with a frequency in the inaudible range in late diastole that is generated by the normal left atrial contraction when the tested person is in NSR and the compliance of the LV is normal. It is when the compliance of the LV is abnormally high in a disease state and the patient is in NSR does the amplitude of the vibration caused by the in flow of blood into a noncompliant LV reach the threshold of audibility that the sound represents an abnormality. The sound now is called a S4 gallop. My point is that Travel makes a distinction between the term S4 heart sound registered on a phonocardiogram as normal and the audible sound detected with auscultation, the S4 gallop as abnormal.

[@malaksa6554]

Thank you.. god bless you

[@TvAanimalia]

explained beautifully😍😍thank u Ma'am