<prompt> All are true about hyperophic cardiomyopathy, except?Systolic dysfunctionDynamic left ventricular outflow tract obstructionDiastolic dysfunctionDouble apical impulse  <response>: HOCM- AD b- myosin gene defect, ch-14 - Asymmetrical septal hyperophy- L-VOTO Left ventricular outflow tract obstruction- characterized by predominant diastolic dysfunction. On Examination :1. Pulsus Bisfiriens aka Jerky Pulse Fast rise initially LVOTO contribution to sudden dip in pressure2. Apex beat- Displaced impulse- Double apical impulse 5 6th IC space3. S2: Narrow split single S2 Reverse Split S2- Splitting is best Heard Best in phase of inspiration- Heard at ERBS Point - 3rd left parasternal IC Space.4. S4 is heard due to out flow obstruction, left atrial hyperophy occurs.5. Ejection systolic murmur CRESENDO- DECRESENDO MURMUR ALL Murmur in intensity with Valsava, Standing, amyl nitrate Except - HOCM Louder SYSTOLIC ANTERIOR MOTIONSAM of valve seen in ECHO. 