Apical hypertrophic cardiomyopathy is a form of nonobstructive hypertrophic cardiomyopathy characterized by disproportionate hypertrophy of the left ventricular apical region. With increasing reports of apical hypertrophic cardiomyopathy appearing in the literature, this condition is certain to be diagnosed amongst airmen. The question of flying status in these pilots may create a problem for the flight surgeon. We present a pilot with clinical and morphological features typical of apical hypertrophic cardiomyopathy who has remained asymptomatic over a 15-year follow-up period. There appears to be a spectrum of severity in apical hypertrophic cardiomyopathy ranging from mild to severe. Those having the mild form of the disease may be considered for restricted licensing subject to having a normal exercise test and no significant arrhythmias on 24-h ambulatory electro-cardiogram. If licensed, review by a cardiologist should be required every 6 months.