A natural history of apical hypertrophic cardiomyopathy with development of an apical aneurysm formation: A case report following a quarter century

Abstract We report the definite long-term natural history of a man with apical hypertrophic cardiomyopathy (ApHCM), who developed an apical aneurysm by the age of 60 years. At 33 years, his electrocardiogram (ECG) was nearly normal. T-wave inversions were first identified in leads V5–6 of an ECG at 36 years of age. Echocardiography first demonstrated a left ventricular (LV) lateral wall hypertrophy at 37 years of age. At 42 years, echocardiography showed the pattern of diastolic spade-like appearance of the LV cavity, confirming the ApHCM diagnosis. At 54 years, a late-peaking apical systolic gradient of 10 mmHg (velocity: 1.6 m/s) emerged. At 60 years, he had developed an apical aneurysm. Cardiac computed tomography revealed no significant major coronary artery stenosis. Thus, in our case, LV hypertrophy and apical high pressure in ApHCM advanced the formation of an apical aneurysm in the absence of coronary artery disease. Learning objective: High apical systolic flow velocity of ≥1.5 m/s in apical hypertrophic cardiomyopathy (ApHCM) using echocardiography may be predictive of the development of apical aneurysm, and make us consider medical intervention by beta-blockers or verapamil to delay or prevent aneurysm formation. Because recent studies have demonstrated that ApHCM may be less benign than previously suspected, observation without medical attention for ApHCM might be hazardous.>