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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 Sound From Lesson

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


Fourth Heart Sound Plus First Heart Sound | #42

Authors and Reviewers

Authored by Dr. Jonathan Keroes, MD and Diane Wrigley, PA. Medically reviewed by William French, MS, RRT. Medically reviewed by Dr. Barbara Erickson, PhD, RN, CCRN, Last Update: 12/06/2021


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