a = aortic closure sound; p = pulmonic closure sound; S 1 = 1st heart sound; S 2 = 2nd heart sound; 3/6 = grade of crescendo-diminuendo murmur (radiates to both sides of neck); 2/6 = grade of pansystolic apical crescendo murmur; 1 + = mild precordial lift of RV hypertrophy (arrow shows direction of lift); 2 + = moderate LV thrust (arrow shows direction of thrust).