What we heard at the lower left sternal edge was a murmur, the configuration of which was crescendo-decrescendo, and the timing was mid systolic. It was also mid frequency, but again, let's listen together - crescendo-decrescendo, mid systolic. Everyone listen, we'll again use the cotton swab to time systole. Lower left sternal edge. [Cut-away]
A crescendo-decrescendo murmur has also been called an ejection murmur, and that is because, most often, the murmur is generated during ejection, or systole, in the outflow tract of the ventricle. Now, most often, that ejection, or crescendo-decrescendo murmur, is heard higher up at the base, and it was heard in our patient at the upper right and left sternal edge. But, in our patient, it was heard with greatest intensity at the lower left sternal edge. That also may be a clue to a diagnosis.
Oscilloscope
By viewing an oscilloscopic image and simultaneously listening, we can further appreciate these auscultatory events.