Hypertrophic cardiomyopathy - apical pattern with midventricular obstruction

Case contributed by Fabien Ho

Presentation

Mild dyspnea upon exertion and mild chest pain.

Patient Data

Age: 45
Gender: Male

apical hypertrophic cardiomyopathy with midventricular obstruction.
LGE and PSIR gado both show patchy midwall fibrosis with subendocardial involvement in the apex. Apical subendocardial necrosis may have been involved in chest pain.
No thrombus.

Case Discussion

This pattern of sarcomeric hypertrophic cardiomyopathy is less common than the anteroseptoapical asymmetrical classical one and less common than the inferoseptal pattern one.
Prognosis with this apical pattern is probably worsened due to increased incidence of adverse cardiac events. 

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