A 65-year-old man arrives at the clinic for a normal visit with a history of hypertension and type 2 diabetes mellitus. The patient had smoked 15 packs over the course of 15 years. He runs three miles each day. 28.5 kg/m² is the BMI. History of the family is unremarkable. Below are the auscultation results above the heart apex. The auscultation findings are best explained by which of the following?

Question

Quizplus · Accepted Answer

Eductional Objective: At the conclusion of diastole, a low frequency, additional heart sound known as an S4 can be heard (just before S1). It results from blood impacting a stiff ventricular wall during atrial contraction; in senior individuals (age > 70), it can be a normal sign, but in younger patients, it usually denotes pathologic ventricular wall stiffness (most commonly due to concentric left ventricular hypertrophy in response to chronic hypertension).

A 65-Year-Old Man Arrives at the Clinic for a Normal