{'fraction_non_alphanumeric': 0.038192827200745225, 'fraction_numerical': 0.009315323707498836, 'mean_word_length': 4.836956521739131, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Incidental diagnosis of apical hypertrophic cardiomyopathy in an 18-year-old white man.

An 18-year-old white man, a non-athlete, presented for follow-up evaluation of an atrial septal aneurysm. The aneurysm had been diagnosed echocardiographically 5 years earlier during investigation of palpitations, which were the patient's only significant symptom. Results of physical examination, electrocardiography (ECG) (Fig. 1), and 21-day monitoring with a CardioNet MCOT™ (CardioNet, Inc.; Conshohocken, Pa) had been within normal limits at that time. The patient had no family history of sudden cardiac death. At the current presentation, ECG showed deep T-wave inversions, which raised suspicions of apical hypertrophic cardiomyopathy (HCM) (Fig. 2). The echocardiographic appearance confirmed the findings (Fig. 3). Magnetic resonance imaging showed apical HCM, and small areas of delayed enhancement were consistent with apical fibrosis (Figs. 4 and ​and5).5). Holter monitoring over 48 hours did not reveal nonsustained ventricular tachycardia. The patient's palpitations corresponded with sinus rhythm. Results of a treadmill stress test showed good exercise capacity for the patient's age, with appropriate elevations in blood pressure during exercise. The patient's parents consented to undergo ECG and echocardiographic evaluation, which yielded no pathologic indications. On the basis of the patient's low-risk factors, placement of an implantable cardioverter-defibrillator was deferred; however, he was discouraged from participating in competitive sports. 
 
 
 
Fig. 1 Normal electrocardiogram at the patient's initial presentation. 
 
 
 
 
 
Fig. 2 Five years after the patient's initial presentation, deep T-wave inversions on the electrocardiogram suggest apical hypertrophic cardiomyopathy. 
 
 
 
 
 
Fig. 3 Echocardiogram shows thickening that suggests apical hypertrophic cardiomyopathy. 
 
 
 
 
 
Fig. 4 Magnetic resonance image shows apical hypertrophic cardiomyopathy. 
 
 
 
 
 
Fig. 5 Magnetic resonance image shows apical hypertrophic cardiomyopathy; small areas of delayed enhancement are consistent with apical fibrosis.