Essential Heart Sounds Fourth Heart Sound (S4) Gallop - waveform Description Waveform Anatomy play pause Maneuver:Supine Position:Mitral Chestpiece: Table of Contents Introduction Normal First and Second Heart Sounds - No Splitting Reduced Intensity First and Second Heart Sounds Split Second Heart Sound Third Heart Sound (S3) Gallop Fourth Heart Sound (S4) Gallop Third and Fourth Heart Sound Gallop Summation Gallop at 120 beats per minute Fixed Splitting of Second Heart Sound Mid-Systolic Click Systolic Murmur - Aortic Stenosis Diastolic Murmur - Aortic Regurgitation Mitral Valve Leaflet Prolapse Pansystolic Murmur - Mitral Regurgitation Diastolic Murmur - Mitral Stenosis