biostudies-literatureUnknown6(8)Jex N<h4>Background</h4>Using serial imaging over time, this case reviews the natural history of co-morbid Type two diabetes (T2D) and apical hypertrophic cardiomyopathy (HCM) and assesses the potential combined impact on myocardial structure and perfusion.<h4>Case summary</h4>A 59-year-old patient with concomitant T2D and an apical phenotype of HCM was seen over a 11-year period with a significant burden of anginal chest pain. Chest pain was refractory to anti-anginal medical therapy and persisted at on-going follow-up. Multi-modality imaging demonstrated significant deterioration in coronary microvascular function and increased myocardial scar burden despite unobstructed epicardial coronary arteries.<h4>Discussion</h4>Comorbidity with T2D and apical HCM resulted in a significant increase in mEuropean heart journal. Case reportsytac347https://www.ebi.ac.uk/biostudies/studies/S-EPMC9425848biostudies-literatureA case report of refractory angina in a patient with diabetes and apical hypertrophic cardiomyopathy.PMC9425848Chowdhary AThirunavukarasu SJex NLevelt EfalseA case report of refractory angina in a patient with diabetes and apical hypertrophic cardiomyopathy.<h4>Background</h4>Using serial imaging over time, this case reviews the natural history of co-morbid Type two diabetes (T2D) and apical hypertrophic cardiomyopathy (HCM) and assesses the potential combined impact on myocardial structure and perfusion.<h4>Case summary</h4>A 59-year-old patient with concomitant T2D and an apical phenotype of HCM was seen over a 11-year period with a significant burden of anginal chest pain. Chest pain was refractory to anti-anginal medical therapy and persisted at on-going follow-up. Multi-modality imaging demonstrated significant deterioration in coronary microvascular function and increased myocardial scar burden despite unobstructed epicardial coronary arteries.<h4>Discussion</h4>Comorbidity with T2D and apical HCM resulted in a significant increase in m2022-01-01T00:00:00Z2022 Aug2025-04-18T22:27:31.56Z2025-04-07T10:13:35.35ZS-EPMC94258483604564710.1093/ehjcr/ytac347