Apical hypertrophic cardiomyopathy, the ace of spades: Detection by contrast tuned imaging echocardiography

Apical hypertrophic cardiomyopathy (AHCM) is a known entity since its first introduction by Sakamoto and Yamaguchi. However, unlike classical hypertrophic cardiomyopathy (HCM), it is less explored in terms of its associated diagnosis and long-term outcomes. Given the increased availability and utilization of ultra-sophisticated cardiac imaging modalities, AHCM will be increasingly recognized as a distinct, clinically significant variant of classical HCM. It is associated with a wide spectrum of presentations ranging from asymptomatic course with incidental findings on imaging to rarely being associated with ventricular arrhythmias, syncope and sudden cardiac death (SCD). Contrast echocardiography is the most effective and diagnostic study when performed in the right setting with high suspicion on clinical and typical electrocardiogram (ECG) findings. Cardiac magnetic resonance imaging (CMR) has an equal diagnostic yield as a contrast echocardiogram. We are presenting a unique case report of a 57-year-old gentleman with asymptomatic AHCM, which was distinctly delineated after utilizing contrast tuned imaging (CnTI) echocardiography sans administration of intravenous contrast agents. This is the first case report of AHCM portrayed by this ingenious technology.