This is a simulation of Cardiomyopathy - Congestive Moderate taken at the apex.

1. Note that S1 is softer than normal due to decreased LV contractility.

2. S2 is normal at the Apex.

3. An S3 is present due to left ventricular failure.

4. A rectangular, medium-pitched murmur of mild mitral insufficiency is due to a dilated mitral valve annulus.