Young Iraqi man with atypical chest pain and pre-syncope.
Sinus rhythm at 66/minute
Axis is 0°
Intervals are normal
Voltage is suggestive of LVH with R waves ≥ 12mm in aVL
Impressive, deep and symmetrical T wave inversion in multiple leads
This striking EKG is typical of an unusual form of hypertrophic cardiomyopathy – apical hypertrophic cardiomyopathy, or Yamaguchi syndrome. This type of HCM is relatively common in the Japanese population, where it was first described, but occurs rarely in other populations (3% of all hypertrophic cardiomyopathy in the US).
This seems a good time to review the causes of “giant inverted T waves”
- CNS events (particularly SAH)
- Takosubo cardiomyopathy
- Wellen’s syndrome (critical LAD lesion during pain-free period) – V2-4
- Hypertrophic cardiomyopathy (particularly apical hypertrophy type)
- Memory T waves with VVI pacing
Siewe D, et al. King of hearts for ace of spades: apical hypertrophic cardiomyopathy. Am J Med 127:31-33, 2014.
Yamaguchi H, et al. Hypertrophic nonobstructive cardiomyopathy with giant negative T waves (apical hypertrophy). Am J Cardiol 44:401-412, 1979.
Pillarisetti J, Gupta K. Giant inverted T waves in the emergency department: case report and review of differential diagnosis. J Electrocardiol 43:40-42, 2010.