Blueberry-on-Top Phenomenon in Apical Variant Hypertrophic Cardiomyopathy

Figures

• 

  Figure 1. Electrocardiogram demonstrates AF with deep negative T waves in the precordial leads.

• 

  Figure 2. Two-dimensional TTE, apical 4-chamber view in diastole (A) and systole (B), demonstrates progressive mid-to-apical LV wall thickness and severe biatrial dilation.

• 

  Figure 3. Two-dimensional TTE, apical 3-chamber view, diastolic phase, demonstrates LV apical hypertrophy with an ace of spades–shaped LV cavity.

• 

  Figure 4. Two-dimensional TTE, apical 5-chamber view without (top) and with (bottom) color-flow Doppler in diastole (left) and systole (right), demonstrates AHCM with a slit-like LV cavity toward the cardiac apex.

• 

  Figure 5. Two-dimensional TTE, apical long-axis view in diastole after administration of an ultrasound-enhancing agent, demonstrates the slit-like LV cavity extending into the apical tip.

• 

  Figure 6. Parametric maps (bull’s-eye displays) of myocardial global longitudinal peak systolic strain (left) and time to peak longitudinal strain (right) demonstrate the characteristic blueberry-on-top patterns.

• 

  Figure 7. Cardiac magnetic resonance imaging (1.5 T scanner), cine spoiled gradient echo sequence, axial 4-chamber view, demonstrates the presence of severe ferromagnetic artifacts (vertical arrows) from biventricular pacemaker generator and leads that obscures visualization of the LV myocardium.