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A previously healthy man in his 40s presented with a 3-month history of progressive dyspnea on exertion. He had inverted T waves in inferior and anterior precordial leads on electrocardiography and marked left ventricular (LV) apex hypertrophy on echocardiography. He was diagnosed as having apical-variant hypertrophic cardiomyopathy and treated with a β-blocker without improvement. Cardiac 4-chamber cine magnetic resonance imaging in steady-state free precession sequence showed obliteration of the LV apex by a large, 5 × 2.5-cm mass consistent with apical LV thrombus and extensive areas of LV endocardial fibrosis. Based on the cardiac magnetic resonance imaging findings, the diagnosis was changed to endomyocardial fibrosis, the patient’s β-blocker was discontinued, and he gradually improved with corticosteroid and anticoagulation treatment. Click the related article link for additional images and full case details.
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