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The apical impulse is thrusting in quality as a result of ventricular hypertrophy. A systolic thrill maximal in the same areas as the murmur and likewise transmitted into the neck is a common, but not invariable accompaniment. An aortic diastolic murmur is often present but without peripheral signs of free aortic incompetence, i.e. undue arterial pulsations. Lowered systolic blood pressure and decreased pulse pressure. Left ventricular enlargement or hypertrophy may be confirmed by radiography and electrocardiography. Calcification of aortic valves may be seen on the radiological screen. The severity of aortic stenosis must be judged by judged by symptoms and the degree of left ventricular hypertrophy. Auscultator findings and blood pressure readings may be misleading.