Apical Hypertrophic Cardiomyopathy (Yamaguchi Syndrome) Presenting as Acute Coronary Syndrome Mimic: A Case Report

Apical hypertrophic cardiomyopathy (ApHCM), or Yamaguchi syndrome, is a morphological variant of hypertrophic cardiomyopathy that frequently mimics acute coronary syndrome (ACS) due to ischemic-type chest pain and characteristic electrocardiographic changes. A 46-year-old woman presented with angina and deep T-wave inversion in precordial leads. Coronary angiography showed normal epicardial arteries. Transthoracic echocardiography revealed localized left ventricular apical hypertrophy with preserved systolic function and the typical "ace-of-spades" cavity configuration, confirming ApHCM. She was managed conservatively with beta-blockers and guideline-directed therapy, with symptomatic improvement. Early recognition prevents unnecessary invasive procedures and facilitates appropriate long-term management.