Table 3.

Left Ventricular Scars in the Apical Region With Specific Disease Characteristics

LV Scar	Distribution	Phenotype	Red Flags		Etiologies	Further Investigation
Apical region	Mid-wall/transmural	HCM	CLINICAL:	•Family history of HCM or SCD	Sarcomeric HCM	Genetic testing
			ECG:	•“Pseudo STEMI” pattern
			ECHO:	•Mitral valve abnormalities: elongated anterior leaflet/SAM
				•Apical or asymmetric LVH
	Subepicardial/transmural	DCM	CLINICAL:	•Origin from endemic countries •Previous flulike illness (chagoma)	Chagas Disease	Testing for parasite specific antibodies
			ECG:	•Normal ECG (2/3 of patients) •Infra-nodal disease
			ECHO:	•Regional wall-motion abnormalities •Apical aneurysms •Mural thrombi

DCM = dilated cardiomyopathy; HCM = hypertrophic cardiomyopathy; LVH = left ventricular hypertrophy; SAM = systolic anterior motion; SCD = sudden cardiac death; STEMI = ST-segment elevation myocardial infarction.