We report the case of a patient with recurrent admissions for congestive heart failure who was subsequently diagnosed with apical hypertrophic cardiomyopathy. The major physiologic characteristic of patients with apical hypertrophic cardiomyopathy is diastolic dysfunction due to abnormal stiffness of the left ventricle during diastole, with resultant impaired ventricular filling. In these patients, as in all patients with hypertrophic cardiomyopathy, the main pathology is inadequate relaxation of the ventricle; therefore, a regimen of diuretics and inotropic agents can actually worsen the clinical picture. We emphasize the need to consider hypertrophic cardiomyopathy in evaluating cases of congestive heart failure.