S4 Heart Sounds Introduction

Introduction

Learn about the S4 heart sound, listen to examples, take short lessons and compare to other heart sounds. For all medical professionals.

Our S3 and S4 heart sound lessons can be found in this course. Secondly, our reference index is designed to provide quick access to stridor sounds, with audio tracks, listening guides and waveforms. Use this link for quick reference to heart and lung sounds.

What is an S4 Heart Sound?

Fourth heart sounds are low in frequency, occurring just before the first heart sound. It is best heard with the stethoscope's bell. The S4 heart sound creates a cadence which is like the word 'Tennessee', where the syllable 'Ten' is S4.

Listening Tips

Listen for a short, low frequency sound early in diastole. Try to match the cadence to 'Tennessee'.

Audio Playback

The patient's position should be supine.

Waveform

Compare To S3

The patient's position should be supine.

Heart Sounds Reference Guide

Our auscultation reference guide provides quick access to this sound as well as many other adventitious sounds. Each sound is described also with an audio recording and waveform.

Heart Sounds Reference Guide

Authors and Reviewers

Authored by Dr. Jonathan Keroes, MD and David Lieberman, Developer, Virtual Cardiac Patient.
Medically reviewed by Dr. Barbara Erickson, PhD, RN, CCRN.
Last Update: 12/12/2021.