Apical hypertrophic cardiomyopathy: Bedside diagnosis by intravenous contrast echocardiography

Apical cardiomyopathy is rare In the West. The characteristic appearance on left ventriculography has been used to confirm the diagnosis of this condi tion; transthoracic echocardiography can also be useful in this regard. How ever, apical artifacts may obscure the typical appearance during echocardio graphy, and although the advent of tissue harmonic echocardiography has res ulted in improved image quality, the technique still may be inadequate in t he establishment of a diagnosis, We hypothesized that contrast echocardiogr aphy, which improves endocardial border delineation, may be the technique o f choice for the diagnosis of apical hypertrophic cardiomyopathy, We report the case of a 40-year-old woman with Down syndrome who had chest pain. The electrocardiogram showed T-wave changes in the lateral precordial leads, b ut cardiac enzymes were normal. Tissue harmonic echocardiography showed api cal akinesia. Intravenous contrast echocardiography, however, revealed typi cal features of hypertrophic apical. cardiomyopathy. Thus contrast echocard iography may be used to establish the diagnosis of this condition.