Some nurses say that there are some patients that don’t have an S3, and S4. Some nurses are convinced that only patients who are sick have it, but it’s been my experience that everyone has all of them and that’s the norm.
So I’d like to know some more opinions about this. Do all patients have S1, S2, S3, and S4?
Is it possible that someone has an S1 and S2, but no S3 or S4? Or is it just that we all have them, but they are just harder to hear in some patients?
If you can hear S3 and S4 does that mean the patient is sick?
S4 is a classic sign of congestive heart failure. An S4 can usually be heard when there are heart problems. you will hear this in anyone with compromised heart function, regardless of whether they’re stable or not. USUALLY.
Patients who are in an acute episode of CHF or are not compensating well.
an S3 after an S2 is caused by early diastole and is the blood entering the ventricle when it is already full and that is what causes the noise you hear. Thus, it’s often heard in people with heart failure where a low ejection fraction means there is a lot of retained volume in the ventricle. Thus, in
So patients with heart failure and low ejection fraction have a lot of blood volume left in the ventricle after contraction. So it’s pathological for sure if it’s an adult. It can be an electrical problem or CHF.
In kids it can be normal though because they can accept more blood capacity and they can pump a large capacity due to their hyperdynamic circulation. Hope this helps.
S4 (preceding S1 and late diastole) is theorized to be due to atrial kick expelling blood against a tough ventricular wall. Which is nearly always pathological, even in kids.
Almost everyone has four heart sounds within S1 and S2. S1 is M1 & T1 (mitral and tricuspid closure in that order) whereas S2 made up of A2 & P2. M1 & T1 are milliseconds apart.
A2 & P2 physiologically split with inspiration, especially notable in the pediatric population (in fact, truly single S2 is pathological). S1 can be split more audibly: if it’s M1 and T1 splitting it could be RBBB or Ebstein’s anomaly (which occasionally can present late). An opening click of either semilunar valve can make for a split S1 as well. At higher heart rates (esp. seen in the pediatric ages) a split S1 can be hard to differentiate from a gallop. Likewise, a prominent splitting of S2 (physiologically or not) can be confused with a gallop at higher heart rates.