Home›Cardio Topics›Pericardial, Myocardial, Pulmonary, Congenital Heart Disease Apical Hypertrophic Cardiomyopathy Updated April 9, 2020 Variant of HCM.Predominantly effects the apex of the heart.Note the “Ace-of- Spades” appearance in the apical 4 and 2 chamber views characteristic of Apical HCM.