A 62-year-old male patient was admitted to our emergency service with symptom of palpitation and syncope attack. The patient’s palpitation developed about 6 hours prior, and he had a brief period of syncope attack following palpitation. On medical history, the patient had only mild chronic obstructive pulmonary disease. The patient did not have any family history of cardiomyopathy. The patient had tachycardia, irregular pulse, and blood pressure of 130/80 mmHg on physical examination. No pathological findings were present on neurological examination. Electrocardiography revealed an atrial flutter (AFL), left axis deviation, and ST segment depression along with T wave negativity on the leads I, aVL, and V4-V6. Two-dimensional transthoracic echocardiography examination showed an isolated hypertrophy located at the left (LV) and right ventricular (RV) apex with sparing the interventricular and posterior septum (Figure 1, Movie 1, 2). Despite the treatment with IV amiodarone, normal sinus rhythm was not restored. Therefore, the patient was scheduled for electrical cardioversion. After two failed attempts of 125J and 200J of direct cardioversion, sinus rhythm was obtained by 275J biphasic cardioversion. Coronary angiography revealed normal coronary arteries. A cardiac magnetic resonance imaging (MRI) study was performed to confirm diagnosis. On cardiac MRI examination, the four-chamber long-axis view showed a clear illustration of apical hypertrophy both on the LV and RV apex with sparing the interventricular septum (Figure 2, Movie 3). Also, there was no thrombus formation and involvement of interventricular septum, lateral wall of the LV, and free wall of the RV in a twochamber short- and long axis view in cardiac MRI (Figure 3, Movie 4, 5).
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