A patient with hypertension may have an S4 heart sound due to which condition?

The presence of an S4 heart sound, also known as a "tennessee" sound, is commonly associated with conditions that result in decreased ventricular compliance, particularly in the setting of left ventricular hypertrophy (LVH). In patients with hypertension, the heart muscle may undergo hypertrophy due to the increased workload and pressure it faces. This thickening of the heart muscle results in a stiffer left ventricle, which can lead to impaired filling during diastole. When the atrium contracts forcefully to propel blood into a non-compliant ventricle, the resulting turbulence generates the S4 sound.

This relationship highlights the pathophysiological changes that occur in the heart due to chronic hypertension and reinforces the importance of monitoring heart sounds in patients with elevated blood pressure. The other conditions listed do not typically produce an S4 heart sound as a common finding or are characterized by different acute changes in heart dynamics.