Case Report. A 41-year-old Asian woman presented with symptoms of palpitations, shortness of breath and chest heaviness on exertion. Transthoracic echocardiogram revealed severe asymmetrical hypertrophy (posterior wall thickness of 2 cm) and a significant septal wall thickness measuring 3 cm. Mild to moderate mitral regurgitation with a peak outflow tract gradient of 56 mmHg and PA pressure was noted at 52 mmHg. The patient was treated with transcatheter alcohol septal ablation and later with AICD for primary prevention of ventricular tachycardia.