This is an example of moderate aortic stenosis combined with mild aortic regurgitation in a patient with rheumatic heart disease.
The first heart sound is normal.
The second heart sound is unsplit.
There is an aortic ejection click in systole followed by a diamond-shaped systolic murmur.
There is a high-pitched decrescendo murmur which fills the first two thirds of diastole.
In the anatomy tab you can see a thickened left ventricle and thickened but mobile aortic valve leaflets. There is moderate turbulent flow across the aortic valve in systole and mild regurgitant turbulent flow into the left ventricle in diastole.
The turbulent blood flow causes the systolic and diastolic murmurs.