To investigate the diagnostic features of atypical apical hypertrophic cardiomyopathy (AHCM).

The clinical data of one patient with atypical AHCM presented at the Department of Cardiology of the Affiliated Hospital of Jining Medical University from June 2018 to April 2022 were retrospectively analyzed. The diagnostic features of atypical AHCM were summarized and relevant literates were reviewed.

The patient had previously experienced numerous instances of chest pain and tightness. In V₂-V₆ of the ECG, there was T-wave inversion, and the maximum amplitude was 0.8 mV. The results of echocardiography and coronary angiography were normal. According to cardiac function magnetic resonance imaging, the inferior wall (basal segment) was 6.85 mm thick at left ventricular end diastole and the inferior wall (apical segment) was 12.17 mm thick, and the ratio of the thickness in the inferior wall (apical segment) to the inferior wall (basal segment) was 1.78. The left ventricular apical myocardium was also relatively thickened. It displayed a " ace-of-spade" left ventricular silhouette with irregular left ventricular motion. Metoprolol succinate and trimetazidine hydrochloride were administered as symptomatic therapy for the patient′s AHCM. Three months of patient monitoring revealed no discomfort.

Patients with atypical AHCM, especially when early lesions are asymptomatic or have non-specific clinical manifestations, are easily missed. And it usually requires the combination of electrocardiogram and imaging examination to make an accurate diagnosis, especially a complete cardiac magnetic resonance imaging will help reduce the misdiagnosis rate.