Non-obstructive hypertrophic cardiomyopathy
by Franklin B Saksena, Ranganathan Narasimhan, Sivaciyan Vahe

The Art and Science of Cardiac Physical Examination (With Heart Sounds, Jugular and Precordial Pulsations)

by Narasimhan Ranganathan, Vahe Sivaciyan, Franklin B Saksena
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This recording is from a 57 year old man with non-obstructive hypertrophic cardiomyopathy. At the bedside the patient also had a palpable atrial kick. The S4 is audible in this patient even with the patient sitting up. If it were truly an S4 then it would indicate severe decrease in ventricular compliance as seen in hypertrophic cardiomyopathy.

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