A 32-year-old man with a four-year history of congestive heart failure was referred to our institution. Two years previously, the patient had received a diagnosis of idiopathic dilated cardiomyopathy with severe secondary mitral insufficiency. Clinical reappraisal focused attention on the following features: (1) normal coronary arteries at angiography; (2) constantly elevated creatine phosphokinase (CPK) plasma values (300–450 mU/ml); (3) localised inferobasal left ventricular akinesia …