We read the case by Kalra et al illustrating an example of coronary embolism originated into an apical aneurysm in a patient with hypertrophic cardiomyopathy (HC). These apical aneurysms are usually seen in severe midapical forms of the disease that can cause dynamic obstruction at the midventricular level and, occasionally, the development of a noncontractile apical aneurysm, which portends increased arrhythmic and cardioembolic risk. Because of the potential source of thrombus that they convey, the investigators emphasize the need for consideration of long-term oral anticoagulation in these patients, although administrated not indiscriminately to all of them, but on the basis of a “case-by-case” basis. As the investigators pointed out, in the largest published review on patients with HC, apical aneurysms were present only in about 2% of them, but the rate of both cardiac embolism and apical thrombus within the aneurysm was high, as it happened in 4 of 28 patients (14%) with apical aneurysm. Thus, these specific forms of HC have potentially a significant risk of thrombus formation. However, controversies exist on whether these patients should be routinely treated with long-term oral anticoagulation. As a consequence, we are concerned about the optimal management of the anticoagulation on this specific group of patients because the consequences of a cardiac embolic event are often devastating. The 2011 American College of Cardiology Foundation/American Heart Association guidelines on HC recognize the superior ability of magnetic resonance over echocardiography in the detection of apical aneurysms and highlight that anticoagulation could be considered on the basis of the morphologic appearance of the aneurysm, supposedly in those with a transverse dimension of at least 3 cm, based on the mentioned reference. However, as Kalra et al explain in their report, the size of the apical aneurysm is not always related to the thrombus formation, and thus, caution should be exercised regarding to the recommendation of these guidelines. The recently published 2014 European Society of Cardiology guidelines on HC recommend the long-term anticoagulation only if a thrombus is detected within the apical aneurysm. At this point, it seems crucial the early detection of the apical thrombus. For this purpose, the best imaging technique nowadays is the cardiac magnetic resonance, which is able to detect both the transmural enhancement of the thinned apical wall and the thrombus that will warrant the start of long-term oral anticoagulation. The questions we would like to share are, first, whether patients with HC and apical aneurysm should be evaluated routinely by cardiac magnetic resonance instead of the widely available but less powerful echocardiography, to properly rule out the apical thrombus, and second, if these patients should be screened periodically for the detection of apical thrombus, that is at which interval the cardiac magnetic resonance should be repeated. Giving that the investigators of the report are authorized experts in the field, working in representative institutions with a huge experience in HC, we are sure that their opinion would be of interest for the medical community. We would like to know if in the mentioned “case-by-case” basis for the indication for anticoagulation, the periodical use of cardiac magnetic resonance could play a role, to allow the early detection of the potentially harmful apical thrombus.