A 43-year-old male with no past medical history presented with acute onset palpitations, chest pain and diaphoresis. Electrocardiogram showed atrial fibrillation with rapid ventricular response. High-sensitivity cardiac troponin I was elevated at 87 ng/L at presentation and rose further to 1874 ng/L 8 hours later. Invasive coronary angiography revealed significant stenosis of the left circumflex artery, which was treated with percutaneous coronary intervention. Transthoracic echocardiography showed severe left ventricular hypertrophy with mild systolic anterior motion of the anterior mitral leaflet. Cardiac magnetic resonance demonstrated features consistent with hypertrophic cardiomyopathy with regional fibrosis. Of note, focal delayed enhancement was seen in the anterolateral papillary muscle.

A 43-year-old male with no past medical history presented with acute onset palpitations, chest pain and diaphoresis. Electrocardiogram showed atrial fibrillation with rapid ventricular response. High-sensitivity cardiac troponin I was elevated at 87 ng/L at presentation and rose further to 1874 ng/L 8 hours later. Invasive coronary angiography revealed significant stenosis of the left circumflex artery, which was treated with percutaneous coronary intervention. Transthoracic echocardiography showed severe left ventricular hypertrophy with mild systolic anterior motion of the anterior mitral leaflet. Cardiac magnetic resonance demonstrated features consistent with hypertrophic cardiomyopathy with regional fibrosis. Of note, focal delayed enhancement was seen in the anterolateral papillary muscle.

A 43-year-old male with no past medical history presented with acute onset palpitations, chest pain and diaphoresis. Electrocardiogram showed atrial fibrillation with rapid ventricular response. High-sensitivity cardiac troponin I was elevated at 87 ng/L at presentation and rose further to 1874 ng/L 8 hours later. Invasive coronary angiography revealed significant stenosis of the left circumflex artery, which was treated with percutaneous coronary intervention. Transthoracic echocardiography showed severe left ventricular hypertrophy with mild systolic anterior motion of the anterior mitral leaflet. Cardiac magnetic resonance demonstrated features consistent with hypertrophic cardiomyopathy with regional fibrosis. Of note, focal delayed enhancement was seen in the anterolateral papillary muscle.

A 43-year-old male with no past medical history presented with acute onset palpitations, chest pain and diaphoresis. Electrocardiogram showed atrial fibrillation with rapid ventricular response. High-sensitivity cardiac troponin I was elevated at 87 ng/L at presentation and rose further to 1874 ng/L 8 hours later. Invasive coronary angiography revealed significant stenosis of the left circumflex artery, which was treated with percutaneous coronary intervention. Transthoracic echocardiography showed severe left ventricular hypertrophy with mild systolic anterior motion of the anterior mitral leaflet. Cardiac magnetic resonance demonstrated features consistent with hypertrophic cardiomyopathy with regional fibrosis. Of note, focal delayed enhancement was seen in the anterolateral papillary muscle.