Development of apical hypertrophic cardiomyopathy.

A 40-year old male patient with a mild, rather diffuse hypertrophic cardiomyopathy (HCM) developed a marked apical hypertrophy of the left ventricle during nine years of observation. The apical HCM showed a characteristic "ace of spades" diastolic configuration on the left ventriculogram. There was no change in the patient's symptoms or haemodynamics. The ECG showed constantly inverted T-waves whereas the precordial QRS amplitude and the corrected QT-interval increased during the observation period. Previous studies have proposed that abortive forms of the apical HCM exist that might become complete later. The present case demonstrates that such a morphological change can take place and that the clinical and haemodynamic picture can be unaffected by the progression of the left ventricular hypertrophy.