This 45-year-old accountant has been found to have an abnormal ECG during a routine general assessment by his family physician. He is normally active, without cardiac complaints. No previous ECGs are available:

• Sinus rhythm, 66/min
  
• Left ventricular hypertrophy with ST depression and giant negative T waves in the chest leads
  
• Consider the possibility of apical hypertrophic cardiomyopathy
  

His echocardiogram showed normal left ventricular systolic function. Hypertrophy involving the distal infero-lateral and apical wall of the left ventricle, with no outflow-tract or intraventricular gradient. The findings are compatible with non-obstructive hypertrophic cardiomyopathy (apical variant).