CIRCUMSCRIBED HYPERTROPHY OF THE LEFT-VENTRICULAR APEX - DYNAMIC DEVELOPMENT AND LONG-TERM COURSE

History and clinical findings: A 64-year-old obese man had for 15 year s suffered from exercise-independent retrosternal pressure sensation, radiating to the neck and back. Shortly after the onset of these sympt oms he had undergone coronary angiography with negative results. But a t that time the resting ECG showed discrete T wave negativity in the l eft precordial leads. Investigations: At the present admission the ECG showed deeply inverted T waves in the left precordial and limb leads and a positive Sokolow-Lyon index of 4.8 mV. Left ventricular angiogra phy demonstrated in enddiastole a circumscribed myocardial hypertrophy limited to the apex and of typical >>ace of spade<< shape. Diagnosis, treatment and course: Left-heart catheterization and angiocardiograph y provided the diagnosis of circumscribed apical left ventricular hype rtrophy (ALVH). As the patient had only minor symptoms no treatment wa s given. Conclusion: Circumscribed ALVH can show marked dynamic develo pment in long-term observations. If there is marked T wave negativity, even with previously normal LV angiography, circumscribed ALVH should be included in the differential diagnosis. Patients with atypical ang ina pectoris and increasingly suggestive ECC changes should, even if p revious coronary angiography had been negative, undergo transthoracic echocardiography with a high-frequency transducer, special attention b eing paid to muscular changes at the LV apex.