Figure 200r Atrial diastolic (ADG) and ventncular
diastolic (VDG) gallops are recorded in an adult with severe calcific
aortic stenosis. The ADG is associated with a prominent presystolic
apical impulse (a) and the VDG occurs during the rapid filling wave
of the ACG. The carotid pulse has a very slow rate of rise and a markedly
prolonged left ventricular ejection time. The classic diamond-shaped
systolic ejection murmur (SM) is present at the base and apex. Note
the higher-frequency composition of the SM at the apex but preservation
of the crescendo-decrescendo pattern. |