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Apical hypertrophic cardiomyopathy is a variant of hypertrophic cardiomyopathy characterized by apical hypertrophy, deep T-wave inversions in precordial electrocardiogram (EKG) leads, and a ventriculogram shaped like the "Ace of Spades." Patients are often asymptomatic but sometimes present with atypical chest pain, angina, or atrial fibrillation. The deep T-wave inversions on EKG often mimic acute coronary syndrome. Coronary angiogram in these patients is unrevealing, but the characteristic left ventriculogram establishes this diagnosis. The deep T-wave inversions can appear suddenly or deepen over years, making the diagnosis difficult to establish early in the disease. Transthoracic echocardiogram may miss the hypertrophied apex, but echo contrast imaging or cardiac magnetic resonance imaging can reliably confirm the diagnosis and detect apical aneurysms. We present a case of apical hypertrophic cardiomyopathy which was not evident despite many admissions, EKGs, cardiac catheterizations and echocardiograms until the diagnosis was confirmed with left ventriculogram and cardiac magnetic resonance imaging 20 years after initial presentation.

Hypertrophic obstructive cardiomyopathy (HOCM) treated with alcohol septal ablation (ASA) often results in right bundle branch block (RBBB). The effect of RBBB-induced dyssynchrony on cardiac function has not been well described. We sought to determine the effect of ASA-induced RBBB on RV function

Left ventricular end diastolic pressure (LVEDP) is a representation of left ventricular performance. An increased LVEDP correlates to an increased left ventricular workload, which can be seen in pathologic conditions such as an obstructed left ventricular outflow tract (LVOT) in hypertrophic

Alcohol septal ablation (ASA) produces a targeted infarction of the septum, thereby relieving the outflow obstruction in hypertrophic obstructive cardiomyopathy (HOCM). There are several changes in the left ventricle with the relief of outflow obstruction. We sought to determine the medium-term