Which finding may be heard on auscultation of a patient with diastolic heart failure?

In diastolic heart failure, also known as heart failure with preserved ejection fraction (HFpEF), the heart's ability to relax and fill with blood is impaired, which can lead to increased pressure in the heart chambers. The presence of an S4 gallop (also referred to as an atrial gallop) is particularly characteristic of this condition.

The S4 heart sound occurs just before S1 and is associated with late diastolic filling of the ventricles from atrial contraction. It reflects stiffness or reduced compliance of the left ventricle, which is common in patients with diastolic heart failure. This finding indicates that the left atrium is contracting against a stiffened left ventricle, which is characteristic of the pathophysiological changes occurring in diastolic dysfunction.

In contrast, the S3 gallop is more commonly associated with heart failure with reduced ejection fraction (HFrEF) and suggests volume overload or systolic dysfunction. Identifying the presence of S4 is thus critical in diagnosing and understanding the mechanisms behind diastolic heart failure, highlighting the significance of ventricular stiffness and its functional consequences.