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A 79 year old woman with a history of good health presented with sudden cardiac arrest caused by ventricular fibrillation. She was successfully resuscitated and admitted into the coronary care unit. An ECG showed sinus rhythm with left ventricular hypertrophy with T wave inversion over V4–V6. Serial cardiac enzymes were normal. An echocardiogram showed asymmetric septal hypertrophy, midventricular obstruction, and an apical aneurysm. Cardiac catheterisation showed angiographically normal coronary arteries. Left ventriculogram revealed severe left ventricular hypertrophy with systolic midventricular total obstruction and apical aneurysm (below left and right). A peak-to-peak intraventricular pressure gradient of 110 mm Hg was documented during pullback from the apical high pressure chamber (270 mm Hg) to the subaortic low pressure chamber in the left ventricle (160 mm Hg). The patient was subsequently treated with a β blocker and an implantable cardioverter-defibrillator was implanted.