eng Science and Education Publishing American Journal of Medical Case Reports 2374-216X 2022-09-20 10 9 239 243 10.12691/ajmcr-10-9-7 AJMCR20221097 article Muhammad Shabbir Ijaz 1 H.K. Reddy m.shabbir.ijaz.md@gmail.com 2 Department of Medicine, Poplar Bluff Regional Medical Center, Poplar Bluff, Missouri, USA Cardiovascular Institute of Southern Missouri, Poplar Bluff Regional Medical Center, Poplar Bluff, Missouri, USA Hypertrophic cardiomyopathy (HCM) is a genetic disorder of cardiac myocytes with variable penetrance and heterogenous phenotypic expression leading to different morphologies of left ventricular (LV) hypertrophy which are usually associated with dynamic left ventricular outflow tract (LVOT) obstruction. Up to 2 percent of cases of HCM have a morphology of mid-cavity or mid-ventricular obstruction in which LV cavity is divided into two cavities by apposition of the hypertrophied septum and free wall, and is many times associated with pressure gradients between both cavities usually in the range of 50-70 mmHg but as high as 110 mmHg has been reported (3). We present a case of this rare form of mid-cavity obstruction with an exceptionally high intraventricular pressure gradient of 154 mmHg and apical aneurysm formation. http://pubs.sciepub.com/ajmcr/10/9/7/ajmcr-10-9-7.pdf Hypertrophic cardiomyopathy left ventricular outflow tract obstruction intraventricular pressure gradient