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The maverick heart sound
  1. Chance M Witt,
  2. William R Miranda,
  3. Darrell B Newman
  1. Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to Dr Darrell B Newman, Division of Cardiovascular Diseases, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA; newman.darrell{at}

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Clinical introduction

An asymptomatic 29-year-old woman presented for prenatal counselling. She had a history of a heart murmur since childhood and a previous echocardiogram suggesting ‘enlargement of the heart’. Physical exam revealed normal jugular venous pressure and contour. Precordial palpation was unremarkable. Auscultation, however, was abnormal; findings on inspiration and expiration are presented in Figure 1, sound clip.

Figure 1

Phonocardiogram of the patient's heart sounds during respiration with simultaneous electrocardiogram.


Based on the phonocardiogram and online supplementary audio clip, which of the following is correct?

  1. An early diastolic filling sound (S3) is heard, indicating increased right ventricular filling pressures.

  2. An ejection click without respiratory variation …

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