Mid cavity hypertrophic obstructive cardiomyopathy with apical aneurysm

Hypertrophic cardiomyopathy (HCM) with mid-ventricular cavity obstruction and apical aneurysm formation is a rare phenomenon. It is associated with worse outcomes due to increased incidence of ventricular tachycardia, thrombus formation and stroke apart from other traditional HCM complications such as outflow tract obstruction and heart failure. It can occasionally be missed on traditional echocardiography and better delineated by cardiac catheterization on left ventriculogram. We present a case of HCM with mid-ventricular obstruction and apical aneurysm formation who presented with stroke with hospital course complicated by ventricular tachycardia requiring an implantable cardioverter defibrillator.