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.

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