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S3 and S4 is not generally heard. Occasionally it can happen in the following conditions

Causes of S3

  • Left of right ventricular failure
  • Chronic Myocardial infarction
  • Hyperkinetic circulation like severe anemia, thyrotoxicosis
  • Dilated cardiomyopathy

Causes of S4

  1. Ischaemic heart disease
  2. Aortic stenosis
  3. Systemic hypertension
  4. Hypertrophic cardiomyopathy

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