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Figure 3 Four patients with obstructive HCM. In all cases the M-mode echocardiograms showing SAM onset are on top and the Doppler tracings are below. For the two patients on the left, the M-mode is compared with the CW Doppler tracings in the LVOT. For the two patients on the right, the M-mode is compared with the PW Doppler tracings in the LV at the AMV point. In all, the left dashed line indicates Q-wave onset. The right solid line indicates SAM onset. In all four patients SAM onset occurs at a time of low velocity, before the beginning of ejection. In the two patients on the right, SAM onset begins during the Ar wave. Both M-mode and Doppler tracings were recorded on the same study, within a 5-min interval, and were selected for matched RR intervals. Vertical calibrations of CW and PW Doppler tracings are at 1-m/s and 20-cm/s intervals, respectively.
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