Dynamic Changes in Fourth Heart Sound in Type 2 Diabetes: Insights From Visualized Phonocardiography and SGLT2 Inhibitor Adjustment.

ABSTRACT: The fourth heart sound (S4) is an auscultatory marker of left ventricular diastolic dysfunction (LVDD). Additionally, S4 correlates with atrial function, which is typically impaired in patients with Type 2 diabetes (T2D) but can improve with sodium-glucose co-transporter-2 inhibitor (SGLT2i) therapy. This case report highlights the dynamic changes in S4 associated with modification of SGLT2i therapy. An 83-year-old male with T2D and LVDD, confirmed via echocardiography, was treated with SGLT2i therapy for 4 years for glycemic control. The therapy was discontinued in December 2023 because of increased nocturnal urination. Two months after discontinuation, the patient developed pronounced S4, accompanied by mild chest discomfort and worsening of evening leg edema. Resumption of SGLT2i therap

SUBMITTER: Yagi K 

PROVIDER: S-EPMC12360888 | biostudies-literature | 2025

REPOSITORIES: biostudies-literature