Phenotypic overlap in apical hypertrophic cardiomyopathy: one size does not fit all.

Hypertrophic cardiomyopathy (HCM) is characterised by left ventricular hypertrophy with several well-defined phenotypes varying in morbidity and mortality risk. However, phenotypic overlap is seen between apical and mid-ventricular HCM subtypes. We present the case of a woman in her late 20s for whom multimodality imaging rendered a phenotypically overlapping apical HCM (ApHCM) with disparate levels of risk for sudden cardiac death. In doing so, this case illustrates the importance of understanding the complementary role of multimodality imaging in the management of HCM patients with phenotypic overlap and further describes the importance of echocardiographic and cardiac magnetic resonance (CMR) findings as subclinical markers of adverse prognosis in ApHCM.