Cardiac Vascular Nursing Certification Practice Exam 2026 – Your All-in-One Guide to Exam Success!

An S4 heart sound, also known as a "gallop" sound, is typically associated with conditions that lead to a stiff or hypertrophied ventricle. This sound occurs just before the S1 heart sound, when the atria contract to push blood into the stiff ventricle. Essentially, the presence of an S4 indicates that the ventricle is not able to accept blood easily, usually due to decreased compliance or increased stiffness.

Conditions such as hypertension or aortic stenosis lead to left ventricular hypertrophy, causing the ventricular walls to thicken and lose elasticity. When the atrium pushes blood into a stiff ventricle under these circumstances, the resultant turbulence creates the S4 sound. This is particularly observed in patients with conditions that affect ventricular compliance, which is central to the presence of an S4 heart sound.

The other options relate to different physiological states. Volume overload is typically associated with an S3 heart sound, as it involves a rapid filling of the ventricle. Aortic stenosis may lead to increased left ventricular pressure but primarily results in an ejection sound or an S4 only in very advanced stages. Myocardial ischemia generally does not cause the S4 sound directly, as it