A 1964 autopsy specimen from a 76 year old woman admitted in congestive heart failure. A rumbling apical diastolic murmur had led to the conclusion in the past that she had chronic rheumatic heart disease with mitral stenosis. However, it was also noticed that she had an apical systolic thrill, with visible and palpable pulsation, in the second left intercostal space where there was also a systolic thrill. A loud ejection systolic murmur was best heard in this area where there was also a soft early diastolic murmur. Raising the possibility of an additional atrialseptal defect. She died shortly after admission.
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