Which heart finding was documented on physical examination?

• A. S3 gallop
• B. Regular rhythm with no extra sounds
• C. Murmur at the aortic area
• D. S4 gallop

Answer: (D)

S4 gallop is an extra heart sound that comes from the atria contracting against a stiff, noncompliant ventricle, usually heard late in diastole just before S1. Its presence on physical exam points to diastolic dysfunction and decreased ventricular compliance, commonly due to left ventricular hypertrophy from long-standing hypertension, aging, or similar conditions. This makes it a documented abnormal finding. By contrast, an S3 gallop signals volume overload and systolic dysfunction; a murmur at the aortic area suggests valvular disease rather than a noncompliant ventricle; and a regular rhythm with no extra sounds would be a normal finding. Thus, the documented finding aligns with an S4 gallop.