Title : Recognising the spade-shaped heart: A case report on apical hypertrophic cardiomyopathy

Background: Apical hypertrophic cardiomyopathy (ApHCM) is an uncommon morphological variant of hypertrophic cardiomyopathy (HCM) characterised by left ventricular hypertrophy confined to the apex. Diagnosis is frequently delayed due to asymptomatic presentation and potential misattribution of characteristic ECG changes to acute coronary syndrome.

Case Presentation: We report a 41-year-old asymptomatic South Asian male in whom deep T-wave inversions were identified on routine health screening. Multimodality imaging confirmed early ApHCM with a maximal apical wall thickness of 13 mm on cardiovascular magnetic resonance (CMR) and absent late gadolinium enhancement, indicating no myocardial fibrosis.

Conclusion: This case illustrates the value of systematic ECG evaluation, the diagnostic limitations of echocardiography in apical disease, and the pivotal role of CMR in confirming diagnosis and guiding risk stratification.

Keywords: apical hypertrophic cardiomyopathy; cardiovascular magnetic resonance; electrocardiography; sudden cardiac death; risk stratification

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