Examination

Question 1

What causes the first and second heart sounds?

Answer 1

1 - mitral and tricuspid valves closing

2- closure of aortic and pulmonary valves

Question 2

What causes a fourth heart sound?

Answer 2

Atrial contraction into a non-compliant or hypertrophied ventricle

Causes:
Heart failure 
Myocardial infarction 
Cardiomyopathy
Hypertension - pressure overload

Question 3

What are the characteristics of a fourth heart sound

Answer 3

Low pitched

“Always abnormal”