302 CHALLENGING DECISION IN INCIDENTAL APICAL HYPERTROPHIC CARDIOMYOPATHY DIAGNOSIS

Abstract Introduction Apical hypertrophic cardiomyopathy (ApHCM) compared with normal HCM is less frequent, it's more associated atrial fibrillation (AF) and it has different sudden cardiac death (SCD) risk factors. Authoritative recommendations guidelines on diagnosis, family screening especially patient stratification don't exist. Taking decisions ICD implantation can sometimes be challenging. Patient presentation A 66-year-old male a history of arterial hypertension was admitted to our cardiology department because during the last night, while he driving his car, would have lost consciousness having car accident. He rapidly felt well even though doesn't remember what happened few minutes shortly before immediately after event. No witnesses. Due traumatic chest pain went emergency where an electrocardiogram performed evidence negative T waves ST-segment depression V3-V6 leads. Diagnosis management Physical examination didn't show anything relevant. On heart ultrasound had left ventricle ejection fraction apical hypertrophy (maximum thickness 18 mm). underwent coronary angiography which showed coronaries. During hospitalization magnetic resonance performed; described some small areas intra-myocardium delayed enhancement in apex wall. hospitalizations no arrhythmic alarms were detected. Discussion Pharmacological electrical treatment options are based classic aiming reduce symptoms, incidence fibrillation, ventricular arrhythmias, death. Concerning ApHCM, outflow tract obstruction usually absent therefore pharmacological therapeutic benefits may lower than HCM. Regarding prevention, we evaluate according ESC 5-y SCD score include potential markers for ApHCM such as aneurysm, midcavity gradient midventricular underestimation. By way still most used being aware that could lead underutilization. In case, 1.74%, screening, events 15 days hospitalization, previous transient loss (TLOC) dynamics accident, decided follow-up patients cardiomyopathies outpatient clinic explaining TLOC sleep disorder.