Early systolic notch in the apexcardiogram in mitral stenosis

Abstract An early systolic notch on the upstroke of the apexcardiogram (ACG) has previously been reported to occur in mobile left atrial myxoma but has not been noted in valvular mitral stenosis. It has therefore been considered a useful diagnostic sign for myxoma. We report four patients with mitral valve stenosis who had an early systolic notch in the ACG. Myxoma was excluded by catheterization and/or surgery. We feel that the notch is not specific for myxoma and that its finding should be interpreted with caution.