Description

A 53-year-old Caucasian woman suffered an out-of-hospital cardiac arrest and was successfully resuscitated. She had no cardiac history and there was no family history of sudden cardiac death.

A 12-lead ECG showed deep T wave inversion in the anterolateral leads (figure 1A). Two-dimensional echocardiography in the apical four-chamber view demonstrated asymmetric hypertrophy of right and left ventricular apices (figure 1B). Systolic anterior motion of the mitral valve was not present. Cardiac MRI in four-chamber cine view clearly demonstrates asymmetric hypertrophy of right and left ventricular apices with an ‘ace of spades’ appearance to the left ventricular apex (figure 1C, white arrows; video). Prominent mid wall fibrosis is noted on late gadolinium imaging in the maximally hypertrophied apices (figure 1D, white asterisk). Coronary angiography confirmed patent coronary arteries. An implantable cardioverter-defibrillator was inserted and family screening initiated.

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Figure 1

(A) ECG showing deep T wave inversion in anterior leads. (B) Two-dimensional four-chamber echo view showing asymmetric hypertrophy of the right and left ventricular apices. (C) Cardiac MRI four-chamber cine view showing asymmetric apical hypertrophy with ‘ace of spades’ appearance to the left ventricular apex. (D) Cardiac MRI four-chamber view showing mid-wall fibrosis in maximally hypertrophied regions.