0:01

In this next case, we see a 64-year-old female who was sent

0:04

to cardiac MRI to look for infiltrative cardiomyopathy.

0:08

She had a known history of apical hypertrophic cardiomyopathy and presented

0:11

with new chest pain and other problems that led them to believe that she might

0:15

have additional infiltrative cardiomyopathy.

0:18

That part of the study ended up being

0:19

negative, but it's a nice example of apical HCM.

0:22

So, on this first set of cine images, what we see here is that there's relative

0:27

sparing of hypertrophy in the base of the left ventricle.

0:31

You can see these areas of the wall are normal in thickness,

0:34

whereas the mid cavity and the apex in particular are quite thick.

0:39

Let me scroll down through this slower.

0:42

You can see really marked thickening of the apex of the left ventricle.

0:46

So the key teaching points here are, when

0:48

you see apical hypertrophy that looks symmetric, that's oftentimes apical HCM.

0:53

This is a subtype of HCM that's actually more common in Asian populations and can

0:58

actually be associated with an apical aneurysm as well.

1:01

In this case, we don't see an apical aneurysm.

1:03

That's something you certainly need to rule out and comment on in your report.

1:07

One thing to note about apical HCM, unlike regular HCM,

1:11

is that the wall thickness requirements are a little bit different.

1:15

In regular HCM, you want to have a wall

1:17

thickness of approximately a 15mm or greater. In apical HCM,

1:22

sometimes the wall thickness may not quite meet 15mm in the apex,

1:26

but as long as the wall thickness of the apex is one and a half times

1:29

greater than basal segments, that still qualifies for apical hypertrophic

1:34

cardiomyopathy. So I just want to show you

1:37

some more images of this typical case of apical HCM.

1:41

You can see again, the basal segments are

1:43

normal in thickness, whereas the apical segments are quite hypertrude.

1:47

And you even have cavity obliteration at the end of systole.

1:50

This is very common for these patients.

1:53

When we go on to the short access images,

1:57

you can see there's this marked thickening of the septum, anterior wall,

2:01

lateral wall and inferior wall with the cavity obliteration.

2:04

And then finally, when we go to the late enhancement images,

2:08

what's common for people with apical HCM is they actually can have quite extensive

2:13

enhancement at the apex where they're involved.

2:15

And you see that in this patient,

2:16

quite a lot of enhancement, very bright, often a lot more bright and kind of stands

2:22

out a lot more than your typical HCM cases.

2:24

I'm not sure it's really known why

2:26

that is, but that is a very typical appearance for apical HCM.

2:30

So the key findings here,

2:33

apical hypertrophy, more so than the base, extensive enhancement in the apex,

2:38

and this is a very typical appearance for apical hypertrophic cardiomyopathy.