CLINICAL-ADDED HEART SOUNDS

SUMMARY

S₃
1. S₃ gallop rythm, sounds like KENTUCKY. 2. S₃: physiological (when < 40yrs), pathological when > 40yrs (LV/RV failure, AR, MR). Caused by tensing of the chordae tendineae in rapid ventricular filling. Poor prognostic indicator.

S₄
3. S₄ gallop rythm, sounds like TENESSEE.
4. Does not occur in AF. Caused by ventricular filling during atrial contraction, due to decreased ventricular compliance.
5. S₄: poor ventricular compliance (cardiomyopathy, IHD, hypertensive heart disease).

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].