S4 Heart Sound Page

Welcome to our S4 heart sound page. On this page we provide a definition and then we compare the s4 heart sound with a normal heart sound and then compare to s3. We also provide hyperlinks to the courses.

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What is an S4 Heart Sound?

The fourth (s4) heart sound is a low frequency sound, that occurs immediately prior to 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.

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Normal and S4 Heart Sound

Compare normal heart sounds to S4 heart sounds.

Normal

• play
• pause

Click to listen.

S4 Heart Sound

• play
• pause

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

Compare a third heart sound (S3) to a fourth heart sound (S4).

S3 Heart Sound

• play
• pause

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

S4 Heart Sound

• play
• pause

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

Fourth Heart Sound Guide

Our auscultation guide provides information and examples of hearts sounds. For S4, the guide pages provide waveforms with a moving cursor that is synchronized to the audio recording. In addition, listening tips are available.
S4 Heart Sound