Q J Med 2015; 108:69–70 doi:10.1093/qjmed/hcu122

Advance Access Publication 2 June 2014

Clinical picture Apical hypertrophic cardiomyopathy: the spade of hearts age with symptoms of palpitations, chest pain or dyspnea. Although autosomal-dominant inheritance has been reported in a few families, the condition is usually sporadic.4 The electrocardiogram typically shows pronounced precordial T-wave inversions. Sudden cardiac death from ventricular arrhythmia has been described, and prophylactic defibrillator implantation is occasionally performed. However, the prognosis is generally more benign than other types of hypertrophic cardiomyopathy.5

Supplementary material Supplementary material is available at QJMED online. Photographs and text from: S. McGraw, Section of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA; A.A. Sovari, Section of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA; O. Mirza, Section of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA; A. Farzaneh-Far, Section of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, IL and Division of Cardiology, Department of Medicine, Duke University, Durham, NC, USA. email: [email protected]

References Figure 1. Cardiac–magnetic resonance cine image demonstrating the classic spade-shaped left-ventricular cavity of apical hypertrophic cardiomyopathy.

1. Yamaguchi H, Ishimura T, Nishiyama S, Nagasaki F, Nakanishi S, Takatsu F, et al. Hypertrophic nonobstructive cardiomyopathy with giant negative T waves (apical hypertrophy): ventriculographic and echocardiographic features in 30 patients. Am J Cardiol 1979; 44:401–12.

! The Author 2014. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: [email protected]

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A 42-year-old policeman with no prior medical problems presented with a several-month history of intermittent palpitations without syncope. His electrocardiogram showed sinus rhythm with prominent precordial T-wave inversions. Echocardiography was suboptimal due to poor acoustic windows. Cardiac–magnetic resonance imaging demonstrated the classic spade-shaped left-ventricular cavity of apical hypertrophic cardiomyopathy (Figure 1 and supplementary video). Apical hypertrophic cardiomyopathy is a form of hypertrophic cardiomyopathy predominantly involving the left ventricular apex.1 It is most common in Japan but also seen in western populations. Apical thrombus, left-ventricular non-compaction and endomyocardial fibrosis may create a similar echocardiographic appearance, which can be distinguished from apical hypertrophic cardiomyopathy using cardiac–magnetic resonance imaging.2,3 Patients are typically male and present in middle

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Clinical picture

2. Noureldin RA, Liu S, Nacif MS, Judge DP, Halushka MK, Abraham TP, et al. The diagnosis of hypertrophic cardiomyopathy by cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2012; 14:17. 3. Moon JC, Fisher NG, McKenna WJ, Pennell DJ. Detection of apical hypertrophic cardiomyopathy by cardiovascular magnetic resonance in patients with non-diagnostic echocardiography. Heart 2004; 90:645–9.

4. Arad M, Penas-Lado M, Monserrat L, Maron BJ, Sherrid M, Ho CY, et al. Gene mutations in apical hypertrophic cardiomyopathy. Circulation 2005; 112:2805–11. 5. Eriksson MJ, Sonnenberg B, Woo A, Rakowski P, Parker TG, Wigle ED, Rakowski H. Long-term outcome in patients with apical hypertrophic cardiomyopathy. J Am Coll Cardiol 2002; 39:638–45.

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Apical hypertrophic cardiomyopathy: the spade of hearts.

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