Cerebrovascular disease as the initial manifestation of apical hypertrophic cardiomyopathy

Apical hypertrophic cardiomyopathy (AHCM) is a condition that primarily involves the apex of the left ventricle. Two of its main characteristics are a non-obstructive physiology and apical hypertrophy of the left ventricle with giant negative T waves. AHCM is uncommon, and its prevalence is notably affected by ethnicity. The diagnosis is challenging to make and requires multimodal imaging techniques. Here we describe two cases of AHCM with cerebrovascular disease as the presenting condition: Patient 1 had atrial fibrillation (AF), while Patient 2 showed evidence of aortic plaques as the possible embolic source. Nonetheless, Patient 2 also presented an akinetic apex. Hence, it was impossible to rule out the previous migration of an apical thrombus as the cause of the ischemic stroke. The main clinical lesson learned from our cases is that stroke in patients with AHCM is a multifactorial complication potentially caused by AF, aortic plaques, and intracavitary thrombus. Therefore, although AHCM is uncommon, it should be considered when determining the cause of cerebrovascular embolic events. (author)