Fourth heart sound
The sound produced in late diastole in association with ventricular filling due to atrial systole and related to reduced ventricular compliance. It is a low frequency oscillation that may be normal at older ages owing to a physiologic decline in ventricular compliance but is nearly always abnormal at younger ages if it is of high intensity or palpable. It is common in ventricular hypertrophy, particularly with hypertension, and is almost invariable during acute myocardial infarction. Fourth heart sounds may arise from the right or left ventricle or both.