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Middle-aged man with exertional angina
  1. Dinkar Bhasin,
  2. Gaurav Kumar Arora,
  3. Hermohander Singh Isser
  1. Department of Cardiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, Delhi, India
  1. Correspondence to Professor Hermohander Singh Isser, Department of Cardiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi 110029, Delhi, India; drhsisser{at}

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Clinical introduction

A man in his 50s presented to our clinic with exertional angina. The patient did not have any prior cardiovascular illness and cardiovascular examination was unremarkable. The ECG showed left ventricular (LV) hypertrophy and a routine echocardiogram revealed normal LV function with normal valves. The patient remained symptomatic despite optimal medical therapy, and a coronary angiogram was done which revealed non-obstructive coronary artery disease. A left ventriculogram was also done during coronary angiography (figure 1).

Figure 1

Left ventriculogram in right anterior oblique projection.


What is the diagnosis?

  1. Apical hypertrophic cardiomyopathy

  2. Takotsubo cardiomyopathy

  3. Endomyocardial fibrosis

  4. Apical thrombus

Answer: A

The image shows left ventriculographic frames …

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  • Contributors All authors have contributed to design, data acquisition, draft preparation and final review of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.