A 65-year-old man with a history of myocardial infarction has an S4 gallop on cardiac auscultation. This sound is produced by:

• A Closure of the mitral and tricuspid valves
• B Rapid ventricular filling in early diastole
• C Turbulent flow across a stenotic aortic valve
• D Atrial contraction against a noncompliant ventricle ✓

Explanation

An S4 gallop occurs during late diastole when the atria contract to eject blood into a stiff, noncompliant ventricle. S1 is valve closure, S3 is rapid early filling, and a stenotic valve murmur is distinct from an S4.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.