S4 = “Stiff Wall” ❤️🩹
Late diastolic sound, just before S1
Caused by atrial kick against a stiff ventricle
High-yield causes:
👉 LVH
👉 Long-standing HTN
👉 Restrictive cardiomyopathy
🚫 Never normal
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2 murmurs that get LOUDER with standing:
1/ Most murmurs get softer with standing (↓preload).
2/ But these 2 are different...
- HCM: Worse outflow obstruction.
- MVP: Click moves earlier.
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Most doctors are taught this wrong. ❌
The ventilator doesn't rest after inspiration — it holds the lungs open silently using PEEP. 🫁
Here's what you should know. 👇#MedEd#CriticalCare