Complete systolic obliteration of the left ventricle due to an apical hypertrophic cardiomyopathy in a totally asymptomatic patient.

A 30-years-old man, subjected to an electrocardiogram for screening, showed signs of left ventricular hypertrophy and “giant” inverted T-waves in pre-cordial leads. So, a transthoracic echocardiogram and a Coronary angiography were performed that showed first, a normal ventricular function and second, normal coronary arteries. Luckily, we associated to the Coronary angiography a Ventriculography that revealed a marked hypertrophy particularly in the apex and a 90% complete tele-systolic obliteration of the left ventricle. To better address our diagnosis, we performed a cardiac magnetic resonance that confirmed the Apical Hypertrophic Cardiomyopathy (AHCM) involving concentrically the apex known as “spade-like configuration” and an apical akinesia with slow-flow. Since the patient was totally asymptomatic, he was discharged without any treatment. AHCM is a form of Hypertrophic Cardiomyopathy (HCM) with an hypertrophy of the left ventricular apex. This disease is often sporadic and among the forms of HCM it has a benign prognosis although in > 50% of patients AHCM is symptomatic with chest pain and palpitations. Our patient incredibly never had cardiac symptoms and was always in a good health state, so only thanks to the association of Ventriculography to the Coronary angiography we were able to reach this unusual diagnosis.