• Man Gao, Feifei Zhang, Yuetao Xie, Jialin Li, Xiao Hao, Huiliang Liu, Xiaoyong Qi, and Yi Dang.
• Department of Cardiology, Hebei General Hospital, Shijiazhuang, China.
• Medicine (Baltimore). 2023 Nov 10; 102 (45): e35823e35823.

RationaleApical hypertrophic cardiomyopathy (ApHCM) is a phenotypic variant of hypertrophic cardiomyopathy. Endomyocardial fibrosis and endocardial calcification are especially rare in ApHCM.Patient ConcernsThe main symptoms was chest tightness, palpitation, shortness of breath, and fatigue. Echocardiography and imaging examinations found apical hypertrophy along with endocardial calcification and endomyocardial fibrosis. Abnormal structural changes led to thrombosis and made the left ventricle a flat shape resembling an "apple."DiagnosesThe typical presentations, hypertrophic apex on echocardiography and an elevated N-terminal pro-brain natriuretic peptide level indicated the diagnosis of ApHCM and heart failure with preserved ejection fraction.InterventionsOptimal medical therapy including the administration of ApHCM, heart failure and atrial fibrillation to improve symptoms and life quality.OutcomesSince discharge, the patient could perform normal daily activities and had no discomfort based on the optimal medical therapy.LessonsWe report a ApHCM patients with unusual presentations of endomyocardial fibrosis and apical calcification. This case highlights the importance of understanding the specific pathological changes of ApHCM for treatment and prognosis.Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.

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