Signs vary but may include Bradycardia An LV impulse that is laterally displaced, enlarged, and increased in amplitude A systolic ejection (flow) murmur at the left lower sternal border A 3rd heart sound (S3) due to early, rapid diastolic ventricular filling A 4th heart sound (S4), heard best during resting bradycardia because diastolic filling time is increased Hyperdynamic carotid pulses These signs reflect structural cardiac changes that are adaptive for intense exercise.