4. Abnormal heart rhythms causing palpitations may occur.
5. On examination, hypertrophy of the heart is reflected by a thrusting and forceful apex beat of the heart that can be seen or felt with the palpating hand. A murmur is heard with the stethoscope and has typical characteristics, but the entire examination may reveal little or no abnormalities depending on the stage of the disease.
6. The ECG is usually abnormal with pathologic Q waves in leads I, II, III, aVF, V5, and V6, as shown in Fig. 3.
7. Signs of heart failure are observed in the end stages of the disease. Figure 4 gives an outline of various processes that lead to the end stages which culminate in heart failure or death.

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