A rapid and irregular heart beat is auscultated in this sound.
The rhythm is irregular, some beats are softer than others, and a grade 3-4/6 systolic murmur is heard. There is also a high-frequency, musical grade 2-3/6 systolic murmur present, which is not heard with every beat; this murmur is louder with stronger beats (likely because of a longer diastolic interval that allows more ventricular filling) and softer with beats that have not generated as much pressure (likely because of a shorter diastolic interval that allows less diastolic filling). This type of rhythm, which can sound like tennis shoes in a dryer or bongo drums, is characteristic of atrial fibrillation with mitral insufficiency.