Figure 200s

The apex phonocardiogram is recorded simultaneously with the
ACG and mitral valve echocardiogram. A prominent S4 is widely separated from S1 and is coincident with the rapid upstroke of the "a" wave on the ACG. Asymmetrical septal hypertrophy is present, and the left ventricular cavity is small. At cardiac catheterization, no gradient
was found across the left ventricular oufflow tract.