Incidental diagnosis of apical hypertrophic cardiomyopathy in an asymptomatic elderly patient: The diagnostic value of routine electrocardiography

Background: Apical hypertrophic cardiomyopathy (ApHCM) is a rare variant of hypertrophic cardiomyopathy characterized by myocardial hypertrophy confined to the left ventricular apex. It typically presents in adulthood with symptoms or characteristic electrocardiographic abnormalities. Incidental diagnosis in asymptomatic elderly patients remains uncommon and raises important questions regarding optimal management.
Case Summary: We report the case of a 75-year-old woman with type 2 diabetes and no prior cardiovascular history or family history of cardiomyopathy, who underwent a routine electrocardiogram as part of her systematic diabetic follow-up. The ECG revealed deep giant negative T-waves in the anterior and lateral precordial leads. Transthoracic echocardiography demonstrated apical left ventricular hypertrophy with a characteristic "spade-like" cavity appearance, preserved systolic function, and no intraventricular obstruction, confirming the diagnosis of ApHCM. Given her asymptomatic status, no further investigations were pursued.
Conclusion: This case highlights the diagnostic value of routine ECG in unveiling silent ApHCM, even in elderly patients. It also underscores the need for tailored follow-up strategies in asymptomatic older individuals with this condition.