If a nurse hears an extra heart sound before the S1 heart sound, what should they document this finding as?

An extra heart sound heard before the first heart sound (S1) is documented as the fourth heart sound, or S4. This sound, often referred to as a "gallop" rhythm, is associated with the vibration of the ventricular walls during the late filling phase of the heart, particularly in conditions such as left ventricular hypertrophy or in older adults. S4 is generated when the atria contract to push blood into a stiffened ventricle, resulting in turbulence and producing this additional sound.

The distinction of S4 as occurring before S1 is significant, as it helps to characterize the heart's mechanical activity and can indicate underlying cardiac conditions. Understanding the timing of heart sounds is crucial for appropriate documentation and clinical interpretation related to cardiac health.