Hypertrophic cardiomyopathy complicated by left ventricular apicalaneurysm: a case report and literature review

Background: Hypertrophic cardiomyopathy (HCM) is a genetically determined myocardial disease withheterogeneous clinical expression. The presence of a left ventricular apical aneurysm represents a rare but clinicallyimportant phenotype associated with adverse outcomes.Case report: We report the case of a 57-year-old woman admitted for non–ST-segment elevation acute coronarysyndrome. She had cardiovascular risk factors including obesity, hypertension, and type 2 diabetes. Clinicalevaluation revealed chest pain preceded by palpitations. Electrocardiography showed sinus rhythm with leftventricular hypertrophy and deep Q waves. Cardiac biomarkers were elevated. Transthoracic echocardiographydemonstrated concentric left ventricular hypertrophy involving basal and mid segments with a left ventricular apicalaneurysm and preserved systolic function. Coronary angiography revealed no significant coronary artery disease.Cardiac magnetic resonance imaging confirmed hypertrophic cardiomyopathy with apical aneurysm and myocardialfibrosis. Holter monitoring documented frequent premature ventricular contractions. Discussion: Apical aneurysm inHCM is associated with an increased risk of ventricular arrhythmias, thromboembolic events, and sudden cardiacdeath. Cardiac magnetic resonance imaging plays a pivotal role in diagnosis and risk stratification. Implantablecardioverter-defibrillator implantation and long-term anticoagulation should be considered on an individual basis.Conclusion: HCM with apical aneurysm is an underrecognized but high-risk entity. Early identification and tailoredmanagement are essential to improve clinical outcomes.