ECG Never Lies: A Case of Apical Hypertrophic Cardiomyopathy

Apical hypertrophic cardiomyopathy (ApHCM) is a less common variant of hypertrophic cardiomyopathy, characterized by predominant thickening of the left ventricular apex. We describe a 64-year-old man presenting with dyspnea and T-wave inversions in the lateral precordial leads. Although initial echocardiography was reported as normal, further imaging revealed an "ace of spades" configuration on ventriculography and an anechoic apical area on off-axis views. Contrast echocardiography confirmed apical wall thickening with systolic obliteration. Cardiac magnetic resonance imaging showed patchy late gadolinium enhancement, and Holter monitoring excluded sustained arrhythmias. This case highlights the role of multimodality imaging in ApHCM.