S4 is not seen in :
Answer is A (Ventricular aneurysm) In ventricular aneurysm the ventricle becomes more compliant than normal and offers lesser resistance to .filling and hence no S4 is heard. S4 is characteristically absent in ventricular aneurysm due to increased ventricular compliance. Fouh hea sound (Sa Is low pitched, presystolic sound, produced in ventricle during 2"d rapid filling phase. It is associated with effective atrial contraction. It occurs when there is increased resistance to ventricular filling due to diminished ventricular compliance
Ventricular aneurysm
Mitral regurgitation
Hyperophic cardiomyopathy
Hypeension