Differential Diagnosis for Accentuated fourth heart sound/S4

50 possible diagnoses found. Too many? Narrow results

• Infected organ, Abscesses

  • Myocarditis, acute

• Granulomatous, Inflammatory Disorders

  • Sarcoidosis, myocardial

• Hereditary, Familial, Genetic Disorders

  • Hypertrophic obstructive cardiomyopathy

• Relational, Mental, Psychiatric Disorders

  • Mania

• Anatomic, Foreign Body, Structural Disorders

  • Arteriovenous fistula/communication
  • Valvular heart disease
  • Aortic regurgitation, acute
  • Chordae tendinae rupture
  • Dissecting aortic aneurysm
  • Mitral valve/acute insufficiency
  • Papillary muscle rupture, mitral
  • Aneurysm, ventricular
  • Cardiomyopathy, restrictive
  • Tricuspid valve insufficiency
  • Mitral valve insufficiency
  • Mitral valve, annular incompetency
  • Tricuspid valve annular incompetency

• Arteriosclerotic, Vascular, Venous Disorders

  • Coronary ischemia
  • Myocardial infarction, acute
  • Pulmonary embolism
  • Arteriosclerotic heart disease
  • Angina pectoris
  • Pulmonary embolism, massive
  • Cardiomyopathy, ischemic
  • Embolism, aortic saddle

• Functional, Physiologic Variant Disorders

  • Hyperpyrexia

• Vegetative, Autonomic, Endocrine Disorders

  • Hypertensive heart disease
  • Atrial flutter
  • Hyperthyroidism (Graves disease)
  • Pulmonary hypertension/PAH
  • Hypertension, malignant
  • Complete heart block
  • Cor pulmonale
  • Hypertension, accelerated
  • Hypertension

• Reference to Organ System

  • Anemia
  • Anemia, severe
  • Congestive heart failure
  • High output heart failure
  • Left ventricular hypertrophy
  • Myocardial disorder
  • Acute cor pulmonale
  • Cardiomyopathy
  • Right Ventricular hypertrophy
  • Papillary muscle dysfunction

• Idiopathic, Unclassified Disorders

  • Cardiomyopathy, idiopathic

• Pathophysiologic

  • High end-diastolic LV pressure/status
  • Left Ventricular outflow obstruction
  • Right Ventricular outflow obstruction

• Drugs

  • Epinephrine (Adrenalin) Administration/Toxicity