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These images show a triphasic pattern of left ventricular (LV) filling in a symptomatic 15 year old patient with non-obstructive hypertrophic cardiomyopathy. This pattern of LV filling is unusual. The sequence clearly demonstrated three separated filling waves. The underlying mechanism seems to be a mixed pattern of restrictive filling and delayed impaired relaxation. The tissue Doppler image in this case is compatible with the recognised diastolic asynchronisation found in hypertrophic cardiomyopathy. The third annulus longitudinal movement may be caused by an extra myocardial relaxation, with suction capacity.