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©2013 UpToDate ® Print Email Apical 5-chamber echocardiogram showing systolic anterior motion (SAM) of the mitral valve (MV) in a patient with hypertrophic cardiomyopathy (HCM) Apical 5-chamber transthoracic echocardiogram showing minimal systolic anterior motion (SAM) of the mitral valve under basal resting conditions (panel A) which is markedly worsening during exercise (panel B) resulting in mitral-septal contact and obstruction in the left ventricular outflow tract. Reproduced with permission from: Maron MS, Olivotto I, Zenovich AG, et al. Hypertrophic cardiomyopathy is predominantly a disease of left ventricular outflow tract obstruction. Circulation 2006; 114:2232. Copyright © 2006 Lippincott Williams & Wilkins.