In this episode of Master the exam, we explore a subtle but powerful finding on cardiac auscultation — the fourth heart sound, or S4.

Follow the story of a 62-year-old man with exertional dyspnea and a soft extra heart sound that changes everything. You’ll learn how to recognize S4, what it means physiologically, and why it’s one of the most testable clues in heart failure with preserved ejection fraction.

We’ll break down how to:

• Differentiate S4 from other sounds

• Understand its link to chronic hypertension

• Eliminate wrong answer choices on the exam

If you’re prepping for Step 2 CK, this episode will give you an edge on cardiac auscultation questions.

Study smart. Master your craft. And stay tuned for more.