S4 is seen in all of the following, Except:
Answer is C (Atrial Fibrillation) Atrial contraction must be present for production of' S4. It is absent in atrial fibrillation. Thyrotoxicosis. Acute MI, and Hyperophic cardiomyopathy are all associated with pathological fouh Hea sound (S4). Fouh Hea Sound (S4): Low frequency sound (low pitched)Q It is a diastolic hea sound that occurs sholy before S1 Q It occurs during the phase of ventricular filling and is associated with an effective atrial contraction Atrial contraction must be present for production of an S4Q It is best heard at the apex in the left lateral position It is better heard with the bell of the stethescopeQ Causes of Pathological Fouh Hea sound Fouh Heah Sound (S4), Atrial Diastolic gallop, and Presystolic Gallop: Decreased ventricular compliance Ventricular hyperophy - Left or right ventricular outflow obstruction - Systemic or pulmonary hypeension - Hyperophic cardiomyopathy Ischemic hea disease - Angina pectoris - Acute myocardial infarction - Old myocardial infarction - Ventricular aneurysm Idiopathic dilated cardiomyopathy Excessively rapid late diastolic filling secondary to: Vigorous atrial systole Hyperkinetic states - Anemia - Thyrotoxicosis Aeriovenous fistula Acute atrioventricular valve incompetence Arrhythmias Hea block Physiologic S4 may be recordable, but is rarely audible
Thyrotoxicosis
Acute MI
Atrial fibrillation
Hyperophic cardiomyopathy