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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 Audio

auscultation sound from lesson
waveform

Patient Sounds

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

Half Speed Patient Sounds

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

Technique

Patient position
The patient's position should be supine.

Auscultation Tips

Diastole:S4 present - a low-pitched sound

Sound Wave



Observe Cardiac Animation

Authors and Sources

Authors and Reviewers


Sources

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Fourth Heart Sound Plus First Heart Sound | #42
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