The differential diagnoses of T-wave inversions are diverse and ischemia, inflammation, electrolyte abnormalities, cocaine use, trauma, and others. Apical hypertrophic cardiomyopathy (HC) is a subtype of HC in which myocardial hypertrophy predominantly involves the apex of the left ventricle. Diagnosis is based on the presence of typical giant inverted T waves in midprecordial derivations (3) and spadelike view in ventriculography, cardiovascular magnetic resonance (MRI) and computed tomography(CT). Non-contrast echocardiography has been the usual first line investigation. However, echocardiography has limitations for visualising the apex and apical hypertrophy and may miss apical HCM. In this case report, we will present a patient with giant T wave inversion and inconclusive echocardiography which lead us to the diagnosis of apical HCM.

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