We are what we repeatedly do. Excellence then, is not an act, but a habit.
~ Aristotle
S4 - an atrial gallop - produced by an atrial contraction pushing blood into a stiff non-compliant left ventricle - sign of concentric LV hypertrophic i.e. 2° to HTN, restrictive cardiomyopathy, acute MI.
https://www.easyauscultation.com/cases/35/fourth-heart-sound-gallop
