A 20-year-old woman was seen initially complaining of mild dyspnea after climbing two flights of stairs. She also stated she had undergone open heart surgery in April 1968.
Results of a physical examination indicated the patient was in no visible distress. Vital signs disclosed a blood pressure of 136/68 mm Hg in the right arm, with no substantial difference in the left arm. The pulse rate was regular at 76 beats per minute. Findings from the cardiovascular examination indicated normal jugular venous pulses and carotid upstroke. The point of maximal impulse was 2 cm in the fifth intercostal space at the midclavicular line. The patient was noted to have a right parasternal lift without palpable thrills. On auscultation, S1 was of normal intensity and S2 was physiologically split. A grade 1 to 2/6 midsystolic crescendo decrescendo murmur was heard best at the left third and fourth intercostal space