We report the use of tissue velocity and strain rate imaging for detecting marked segmental variations and asynchrony in left ventricular systolic and diastolic functions of a 40-year-old patient with hypertrophic obstructive cardiomyopathy who died of an intractable ventricular tachycardia. These newer techniques have advantages for identifying heterogeneity in regional myocardial function in hypertrophic cardiomyopathy.