CC BY-NC-ND 4.0 · Indian Journal of Cardiovascular Disease in Women - WINCARS 2020; 5(02): 155-164
DOI: 10.1055/s-0040-1713828
Clinical Rounds

Additional Heart Sounds—Part 1 (Third and Fourth Heart Sounds)

Ramya Pechetty
1  Department of Cardiology, Apollo Hospitals, Hyderabad, India
Lalita Nemani
2  Nizam’s Institute of Medical Sciences, Hyderabad, India
› Author Affiliations


S3 is a low-pitched sound (25–50Hz) which is heard in early diastole, following the second heart sound. The following synonyms are used for it: ventricular gallop, early diastolic gallop, protodiastolic gallop, and ventricular early filling sound. The term “gallop” was first used in 1847 by Jean Baptiste Bouillaud to describe the cadence of the three heart sounds occurring in rapid succession. The best description of a third heart sound was provided by Pierre Carl Potain who described an added sound which, in addition to the two normal sounds, is heard like a bruit completing the triple rhythm of the heart (bruit de gallop). The following synonyms are used for the fourth heart sound (S4): atrial gallop and presystolic gallop. S4 is a low-pitched sound (20–30 Hz) heard in presystole, i.e., shortly before the first heart sound. This produces a rhythm classically compared with the cadence of the word “Tennessee.” One can also use the phrase “A-stiff-wall” to help with the cadence (a S4, stiff S1, wall S2) of the S4 sound.

Publication History

Publication Date:
05 August 2020 (online)

© .

Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India