Asymptomatic Apical Hypertrophic Cardiomyopathy Uncovered During Routine Preoperative Evaluation

Apical hypertrophic cardiomyopathy (ApHCM) is an uncommon, nonobstructive form of hypertrophic cardiomyopathy (HCM) that is associated with an increased risk of ventricular aneurysms, atrial fibrillation, heart failure, and cardiac death. In this case report, a 63-year-old male patient was found to have deeply negative T waves on electrocardiogram (EKG) during a routine preoperative evaluation in an outpatient internal medicine clinic. Imaging with echocardiography and cardiac magnetic resonance confirmed the diagnosis of ApHCM. Once the diagnosis was made, the patient underwent a thorough, guideline-directed evaluation for risk of sudden cardiac death (SCD), including ambulatory cardiac monitoring, cardiac MRI, and genetic testing. The patient continues to receive longitudinal care, including medical therapies with a beta-blocker, and periodic follow-up assessments of SCD risk.