Middle-aged man with exertional angina

A man in his 50s presented to our clinic with exertional angina. The patient did not have any prior cardiovascular illness and cardiovascular examination was unremarkable. The ECG showed left ventricular (LV) hypertrophy and a routine echocardiogram revealed normal LV function with normal valves. The patient remained symptomatic despite optimal medical therapy, and a coronary angiogram was done which revealed non-obstructive coronary artery disease. A left ventriculogram was also done during coronary angiography (figure 1). Figure 1 Left ventriculogram in right anterior oblique projection. What is the diagnosis? 1. Apical hypertrophic cardiomyopathy 2. Takotsubo cardiomyopathy 3. Endomyocardial fibrosis 4. Apical thrombus The image shows left ventriculographic frames …