ECG Abnormalities Preceding Structural Changes of Apical Hypertrophic Cardiomyopathy by up to 10 Years

A 48-year-old man with hypertension and hypercholesterolemia was referred with an abnormal ECG showing signs of myocardial ischemia and structural change consistent with ventricular hypertrophy. Upon further workup with MRI, echocardiogram, and exercise stress test with perfusion images, it was determined that the man had no cardiac abnormalities. Ten years later, the patient developed structural changes consistent with the abnormal ECG. The patient was diagnosed with apical hypertrophic cardiomyopathy and was treated appropriately with an automatic implantable cardiac defibrillator. The objective of this clinical case report is to highlight this unusual incident where ECG changes preceded structural changes within the heart by 10 years.