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Fourth Heart Sound Plus First Heart Sound

Fourth Heart Sound Plus First Heart Sound

Certain heart sound configurations mimic a split first heart sound. One of these conditions is a fourth sound gallop (S4) plus a first heart sound (S1). Since the S4 occurs just before the S1, it is easy to confuse a S4/S1 with a split S1. An S4 is lower frequency than an S1. To differentiate between a S4/S1 and a split S1, listen carefully to the frequency of the initial sound of the pair. If it is lower in frequency than the second sound, it is an S4. If the two sounds are the same, it is a split S1.


Auscultation Sounds

auscultation sound from lesson
waveform


Patient Recording

patient heart or lung sound
Fourth Heart Sound Plus First Heart Sound


Patient Recording - Half Speed Playback

patient heart or lung sound
Fourth Heart Sound Plus First Heart Sound



Position

Patient position
The patient's position should be supine.

Listening Tips

Diastole:S4 present - a low-pitched sound


Waveform (Phonocardiogram)

Observe

//embedding heart animation

Authors

These authors contributed the audio recordings and text found in this reference guide: Jon Keroes, MD,Diane Wrigley, PA, and David Lieberman.
Medically reviewed by Dr. Barbara Erickson, PhD, RN, CCRN.

Sources


Sources




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