Convergence of relative apical hypertrophic cardiomyopathy and acute myocardial infarction in an elderly patient: a case report

ypertrophic cardiomyopathy (HCM) is a primary myocardial disease characterized by myocardial hypertrophy, excluding other cardiovascular or systemic/metabolic causes of ventricular wall thickening.Apical hypertrophic cardiomyopathy (ApH-CM) represents a special form of ventricular hypertrophy predominantly affecting the left ventricular apex below the papillary muscles, typically without significant left ventricular outflow tract obstruction. [1,2]ApHCM often coexists with mild coronary artery abnormalities, [3] and reports of acute myocardial infarction with coronary artery stenosis in ApHCM or HCM patients are uncommon. [4]owever, in the elderly with long-term survival, the likelihood of concurrent of HCM and ischemic heart disease increases.This case report presents an elderly patient with relative ApHCM, [5] accompanied by significant coronary artery narrowing.Relative ApHCM is considered an atypical precursor to ApHCM.In elderly patients, the coexistence of atypical apical hypertrophy and coronary artery disease can sometimes lead to a focus on coronary artery disease while overlooking HCM.Through this case analysis, we aim to provide insights for accurate diagnosis in such patients to prevent missed and misdiagnoses.The patient is a 60-year-old male admitted on February 27, 2023, with a one-month history of intermittent chest pain that worsened over the past ten days.He has a 20year history of hypertension with the peak blood pressure readings of 160/100 mmHg, managed effectively with oral sacubitril/valsartan and bisoprolol fumarate.He had elevated blood sugar levels for two years without treatment and a 40-year smoking history, averaging 15 cigarettes per day.On January 27, 2023, the patient experien-