S 4

heart sounds

 
the sounds heard on the surface of the chest in the heart region; they are amplified by and heard more distinctly through a stethoscope. They are caused by the vibrations generated during the normal cardiac cycle and may be produced by muscular action, valvular actions, motion of the heart, or blood passing through the heart.

The first heart sound (S1) is heard as a firm but dull “lubb” sound. It consists of four components: a low-frequency, indistinct vibration caused by ventricular contraction; a louder sound of higher frequency caused by closure of the mitral and tricuspid valves; a vibration caused by opening of the semilunar valves and early ejection of blood from the ventricles; and a low-pitched vibration produced by rapid ejection.

The second heart sound (S2) is shorter and higher pitched than the first, is heard as a “dupp” and is produced by closure of the aortic and pulmonary valves.

The third heart sound (S3) is very faint and is caused by blood rushing into the ventricles. It can be heard in most normal persons between the ages of 10 and 20 years.

The fourth heart sound (S4) is rarely audible in a normal heart but can be demonstrated on graphic records. It is short and of low frequency and intensity, and is caused by atrial contraction. The vibrations arise from atrial muscle and from blood flow into, and distention of, the ventricles.
Abnormalities in Heart Sounds. Decreased compliance of a ventricle is characterized by a gallop or triple rhythm. Accentuation of the third heart sound (protodiastolic or ventricular gallop) is caused by the filling of a poorly compliant ventricle with blood under high venous pressure. A presystolic or atrial gallop is an accentuated fourth heart sound and is also caused by blood filling a poorly compliant ventricle. Merging of the third and fourth heart sounds is called a mesodiastolic or summation gallop. A very rare abnormality in which four heart sounds are heard distinctly is called a “locomotive” rhythm.

Heart Murmurs are sounds other than the normal heart sounds emanating from the heart region. They are often heard as blowing or hissing sounds as blood leaks back through diseased and malfunctioning valves or as blood is pushed through narrowed or stenotic valve orifices.
Precordial locations for cardiac palpation and auscultation of heart sounds. Closure of the mitral and tricuspid valves produces the S1 heart sound; closure of the pulmonic and aortic (semilunar) valves produces the S2 sound. From Polaski and Tatro, 1996.

S4,

the fourth heart sound in the cardiac cycle. It occurs late in diastole on contraction of the atria. Rarely heard in normal subjects, it indicates an abnormally increased resistance to ventricular filling, as in hypertensive cardiovascular disease, coronary artery disease, cardiomyopathy, and aortic stenosis. A left-sided fourth heart sound, it may be heard with the stethoscope's bell at the apex of the heart during expiration. Also called atrial gallop, physiologic fourth heart sound.

Patient discussion about S 4

Q. i've been having a neckache 4 2 wks what could be causing it?

A. Have you tried changing the way that you sleep?

Q. i am a size 12 and i need to get down to a size 4 fast how do i do it??

A. you are 15- try not to develop an eating disorder..i'm not sure that size 12 is considered overweight for age 15.. (depends on height and some other things) but size 4 is extremely thin for a 15 years old. i mean- an anorexic skeleton. that's not even the least attractive, if that is what you want to accomplish. loosing weight "fast" is always- ALWAYS!! a bad idea. it should be done moderately so your body will have the time to adjust, unless you look for severe health problems.

Q. what could cause leg pains in a 4 yr old?

A. It depends on many factors. Was there any trauma to the leg? In that case the pain may result from fracture or damage to the joint.

Is there any swollen/red/painful joint? In that case the pain may result from inflammation of the joint. Prompt referral to medical treatment is essential since in that case, early treatment may make the save the joint.

Does he have any rash on his legs? Elsewhere on his or her body? Rash with pain in the joint may be due to rheumatologic diseases such as rheumatic fever, henoch-shonlein purpura and many others.

The causes are numerous, and I wrote only a fraction of them. Not to mention the fact that it's practically impossible to diagnose people over the net. Pediatrician is the address in this case.

Take care,

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