# The heart shows a ______ gallop with an extra sound occurring just before S1, indicating atrial contraction against a stiff ventricle.

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> url: https://mymerci.kr/pages/nclex_q.php?qn_id=168400  
> language: ko  
> subject: Diseases of the circulatory system

## 문제

The heart shows a ______ gallop with an extra sound occurring just before S1, indicating atrial contraction against a stiff ventricle.

## 보기

1. presystolic **✔ 정답**
2. systolic
3. diastolic
4. protodiastolic
5. summation

**정답: 1**

## 해설

A presystolic gallop (S4) occurs just before S1 when the atria contract against a stiff or noncompliant ventricle. This additional heart sound is often heard in conditions like hypertensive heart disease or diastolic dysfunction.

## 임상 시나리오

Cardiac Auscultation and Heart Sounds:

1. Heart Sound Sequence:
- S1: Closure of mitral and tricuspid valves
- S2: Closure of aortic and pulmonic valves
- S3: Early diastolic filling
- S4: Late diastolic/presystolic atrial contraction

2. Presystolic Gallop (S4):
- Timing: Late diastole, just before S1
- Cause: Forceful atrial contraction against stiff ventricle
- Associated conditions: Left ventricular hypertrophy, hypertension, ischemia

3. Clinical Characteristics:
- Low-pitched sound
- Best heard at apex
- Intensified during expiration
- More common in elderly patients

4. Pathophysiological Conditions:
- Decreased ventricular compliance
- Diastolic dysfunction
- Increased end-diastolic pressure
- Ventricular wall stiffness

5. Diagnostic Significance:
- Indicator of impaired ventricular relaxation
- Marker of diastolic heart failure
- Sign of increased left ventricular filling pressure

## 핵심 개념

- **presystolic** — Occurring just before systole; specifically referring to the period of atrial contraction immediately preceding ventricular contraction
- **systolic** — Relating to or occurring during systole, when the heart muscle contracts and pumps blood from the ventricles
- **diastolic** — Relating to or occurring during diastole, when the heart muscle relaxes and the chambers fill with blood
- **protodiastolic** — Occurring at the beginning of diastole, during the early phase of ventricular relaxation
- **summation** — The combination of two separate heart sounds occurring close together, typically when S3 and S4 merge due to tachycardia

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