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Introduction: apical hypertrophic cardiomyopathy (HCM) accounts for 15% of patients with HCM in Japan. However, in our country it is a rare diagnosis. In this entity, the apex is almost exclusively affected, most commonly in the left ventricle. It is diagnosed by finding apical thickening greater than 15 mm or a ratio of left ventricular apical to basal wall thickness >1.3-1.5. It is treated symptomatically with beta blockers and automatic defibrillator implantation for primary prevention of sudden death. Case presentation: a 59-year-old patient in whom apical HCM, or Yamaguchi syndrome, was found incidentally. Conclusion: apical HCM is a rare entity, in many cases asymptomatic. Its prompt diagnosis allows early treatment and prevents cardiovascular outcomes, including fatal ones. (Acta Med Colomb 2021; 46. DOI:https://doi.org/10.36104/amc.2021.2082). Resumen Introducción: la miocardiopatía hipertrófica (MCH) apical constituye 15% de los pacientes con MCH en Japón; sin embargo, en nuestro país es un diagnóstico poco frecuente. Esta entidad consiste en la afectación casi exclusiva del ápex, siendo más común su localización ventricular izquierda. Su diagnóstico se da por la visualización de engrasamiento apical mayor a 15 mm o una relación entre el espesor de la pared apical y basal del ventrículo izquierdo >1.3-1.5. Su tratamiento es sintomático a través del uso de betabloqueadores y el implante de desfibrilador automático para prevención primaria de muerte súbita. Presentación de caso: paciente de 59 años que de forma incidental se le confirmó MCH apical o síndrome de Yamaguchi. Conclusión: la MCH apical es una entidad infrecuente, en muchos casos asintomática. Su diagnóstico oportuno permite un tratamiento temprano y prevenir desenlaces cardiovasculares incluso fatales. (Acta Med Colomb 2021; 46. DOI:https://doi.org/10.36104/amc.2021.2082).

Heart transplant is a surgical procedure with a high risk of perioperative bleeding in patients with a previous history of sternotomy, congestive liver disease, and/or use of oral anticoagulants. Anticoagulation is usually done with coumarin agents (warfarin, acenocoumarol), while on the waiting list, vitamin K is available allowing for partial reversal of the anticoagulant effect, although with variable INR and risk of uncontrolled bleeding. Direct oral anticoagulants have emerged as an alternative to the use of coumarins in patients with nonvalvular atrial fibrillation (NVAF). The main disadvantage of this group of drugs is that there was no specific reversal agent available that would allow an urgent reversal of the anticoagulant effect. The recent commercialization of idarucizumab (specific reversal agent) has allowed patients with NVAF on the waiting list for heart transplant to be treated with dabigatran. We present the case of a patient with advanced chronic heart failure and NVAF anticoagulated with dabigatran, who underwent urgent heart transplant after administration of idarucizumab, without complications derived from its use or from anticoagulation.