Figure 2 Apical hypertrophy missed by echocardiography

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Figure 2 Apical hypertrophy missed by echocardiography Figure 2 | Apical hypertrophy missed by echocardiography. An athletic man aged 49 years with no family history of hypertrophic cardiomyopathy presented with atypical chest pain. a | 12-lead electrocardiogram showed deep inferolateral T-wave inversion, but coronary arteries were normal, as was the echocardiogram. Cardiac magnetic resonance demonstrated a discrete increase in wall thickness at the apex (10 mm versus 8 mm basally); b,c | a 14 mm tube-like apical cavity (arrows), which obliterates in systole; d,g | an apical scar (arrows); e | left atrial dilatation; and f | a small apical microaneurysm unobliterated in systole (arrow). A mutation (R810H) was subsequently identified in MYBPC3. Ch, channel; LGE, late gadolinium enhancement. Reprinted from Flett, A. S. et al. Diagnosis of apical hypertrophic cardiomyopathy: T-wave inversion and relative but not absolute apical left ventricular hypertrophy. Int. J. Cardiol. 183, 143–148 (2015), with permission from Elsevier. Reprinted from Flett, A. S. et al. Diagnosis of apical hypertrophic cardiomyopathy: T‑wave inversion and relative but not absolute apical left ventricular hypertrophy. Int. J. Cardiol. 183, 143–148 (2015), with permission from Elsevier Sen-Chowdhry, S. et al. (2016) Update on hypertrophic cardiomyopathy and a guide to the guidelines Nat. Rev. Cardiol. doi:10.1038/nrcardio.2016.140