Extra Heart Sounds (S3 and S4) Third and Fourth Heart Sound Gallop Both the third and fourth heart sounds (S3 and S4) are low frequency. S4 is lower than S3.This is a pattern that occurs with improvement of heart failure. That is, an S3 pattern gives way to an S3 S4 pattern as the patient improves. play pause Position: Mitral Chestpiece: Bell Maneuver: Supine Phonocardiogram Cardiac Animation Table of Contents 1Third Heart Sound Gallop 2Fourth Heart Sound Gallop 3Third and Fourth Heart Sound Gallop 4Summation Gallop at 120 beats per minute Practice Drill