Progression of electrocardiographic changes in a patient with apical hypertrophic cardiomyopathy

A 58-year-old man asymptomatic from the cardiovascular point of view and with no known relevant family history was found by transthoracic echocardiography to have apical hypertrophic cardiomyopathy (AHCM). His electrocardiogram (ECG) revealed prominent precordial R-waves, particularly in V3–V4 leads, and “giant” (>1.0 mV), inverted T-waves, previously associated with AHCM. ECGs recorded 17 and 13 years previously, did not disclose such abnormalities, as the ones of his current ECG. The presented case illustrates a potential role of serial ECGs (along with serial imaging testing) in detecting the development and progression of regional left ventricular hypertrophy in patients with AHCM, and probably in other hypertrophic cardiomyopathy phenotypes.