Apical Hypertrophic Cardiomyopathy Mimicking Wellens Syndrome: A Diagnostic Challenge in a Patient Presenting With Recurrent Angina

Apical hypertrophic cardiomyopathy (ApHCM), also known as Yamaguchi syndrome, is an uncommon variant of hypertrophic cardiomyopathy that may mimic acute coronary syndromes because of its characteristic electrocardiographic abnormalities. We report the case of a 66-year-old man with hypertension, type 2 diabetes mellitus, and active tobacco use who presented with recurrent exertional chest pain and giant symmetric T-wave inversion in leads V2-V6, producing a Wellens-like electrocardiographic pattern that mimicked Wellens syndrome and initially raised suspicion for critical proximal left anterior descending (LAD) artery disease. Coronary angiography demonstrated no significant obstructive coronary artery disease. Transthoracic echocardiography subsequently revealed localized apical hypertrophy with a maximal wall thickness of 14 mm and the characteristic spade-shaped left ventricular cavity, establishing the diagnosis of ApHCM. Treatment with bisoprolol, telmisartan, and atorvastatin resulted in complete symptom resolution, and the patient remained asymptomatic during follow-up. This case highlights the importance of considering ApHCM in the differential diagnosis of patients presenting with giant T-wave inversion and suspected acute coronary syndrome, as recognition of its characteristic electrocardiographic and echocardiographic features can facilitate an accurate diagnosis and help avoid misinterpreting Wellens-like electrocardiographic patterns as true Wellens syndrome.