Contrast Echocardiography for Diagnosis of Apical Hypertrophic Cardiomyopathy

Most patients with hypertrophic cardiomyopathy (HCM) have asymmetric septal hypertrophy; and among them, 25% present dynamic left ventricular outflow tract obstruction. Apical HCM is unusual. Echocardiography has been the first imaging method for patients with suspected HCM, but its shortcomings in evaluating the apex are well known. We present a 56-year-old woman with a history of left hemithorax pain for five years and myocardial perfusion defect in the inferoseptal region, who was a candidate for selective coronary angiography. On echocardiography, a mildly thickened apex was mistaken for apical foreshortening on planar imaging, but contrast echocardiography revealed apical HCM (Iranian Heart Journal 2010; 11 (3): 37-39).