Hypertrophic cardiomyopathy (HCM) is one of the most common inherited cardiomyopathy. The identification of patients with HCM is sometimes still a challenge. Moreover, the pathophysiology of the disease is complex because of left ventricular hyper-contractile state, diastolic dysfunction, ischemia and obstruction which can be coexistent in the same patient. We report a case of 35 year old male presenting with effort dyspnea NYHA class II with ECG showing deep arrowhead T wave inversion in anterolateral leads and TTE revealed it to be HCM with thickened LV posterior wall (26mm) as compared to septum (12 mm) which belongs to Marons Type IV type, rarest across HCM phenotypes. 

Keywords: Cardiomyopathy; Classification; Septum.