Abstract
An 83-year-old lady presented to our cardiac unit with presyncope and progressive dyspnoea.She had a regular bradycardia of 36 beats per minute with a slow-rising central pulse and normal jugular venous pressure without cannon A waves. Auscultation revealed a late-peaking, ejection systolic murmur (ESM) and soft second heart sound in keeping with severe aortic stenosis (AS). Interestingly, 2 added diastolic heart sounds were noted. A phonocardiogram with a simultaneous electrocardiogram (ECG) recording was undertaken using a mobile device. This revealed an early diastolic heart sound following a non-conducted P wave (S4x) in addition to a pre-systolic atrial heart sound (S4) and ESM (Panel A).
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