Heart sounds--gallops

Order of heart sounds: S4-->S1-->S2-->S3

S3

Occasionally heard in healthy children or adults, esp athletes

Occurs in dilated ventricles, for ex:

large VSD

CHF

volume overload

S4

Usually pathologic

Occurs with decreased ventricular compliance , for ex:

Normal (especially athletes)

Hypertensive

Coronary artery disease

Aortic stenosis

Restrictive cardiomyopathy