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case_images: Illustration of the comparison between multi-imaging modalities in a 1-year follow-up period. (A) Previous electrocardiogram (ECG) showed no abnormalities compared to the ECG at current presentation (D), which showed diffuse T wave inversion. (B, E) Myocardial perfusion studies demonstrate side-by-side comparison of new ischemia involving the distal inferior and apical segments. (F) Transthoracic echocardiography show new apical hypertrophy in parasternal short axis with enhancing agent compared to the previous study (C).
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case_images: PMC11192092_01_mdcvj-20-1-1386-g1.jpg
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case_images: Notably, 1 year prior to the current presentation, the patient had a normal 12-lead ECG (Figure 1A), a negative nuclear stress test (Figure 1B), and a TTE showing basal septal hypertrophy (Figure 1C; Video 1). T-waves inversion, which raised suspicion for cardiac ischemia (Figure 1D). Therefore, a nuclear stress test was repeated and demonstrated reversible perfusion defects in the left ventricular apical and periapical areas (Figure 1E). Repeat TTE demonstrated apical hypertrophy as well as prominent papillary muscle that resulted in mid-ventricle crowding (Figure 1F; Video 2, 3); however, no regional wall motion abnormalities were seen.
case_images: Apical four-chamber echocardiography view before diagnosis showing no significant abnormalities; see also at https://youtu.be/NAWtaBxa1lw.. Apical four-chamber echocardiography view after diagnosis showing the apical hypertrophy; see also at https://youtu.be/nC0sTpOcq9c.. Apical two-chamber echocardiography view with contrast after diagnosis showing the apical hypertrophy; see also at https://youtu.be/x6nKidbm-us.. Cardiac magnetic resonance study demonstrates apical hypertrophic cardiomyopathy; see also at https://youtube.com/shorts/nSbHeF8F2Wg.
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case_images: PMC11192092_01_.jpg
case_images: FV1
case_images: Cardiac magnetic resonance (CMR) was performed and showed apical HCM with circumferential apical thickening measuring 17 mm (Figure 2A, B; Video 4). Within the apical septum, minimal fibrosis (qualitatively 5% total left ventricular myocardial volume) was observed(Figure 2C).