Patients with a systolic murmur and an electrocardiogram that suggests a recent or remote myocardial infarction should bring to mind the diagnoses listed here. In younger patients, the presence of ECG changes suggesting a prior infarction should raise the possibility that the ECG changes were caused not by an infarction but by non-infarct related causes. For instance, such changes occurring in a younger patient with a systolic murmur should bring to mind the possibility of hypertrophic obstructive cardiomyopathy with a pseudo-infarct ECG pattern caused by the asymmetric septal hypertrophy.