Chest Discomfort, Abnormal Electrocardiogram, Clean Coronaries

•Apical hypertrophic cardiomyopathy symptoms and electrocardiography can be confused with myocardial infarction.•Giant negative T waves and left ventricular hypertrophy are key electrocardiographic changes•The left ventricle is shaped like an “ace of spades” on imaging due to apical hypertrophy.•Lack of left ventricular outflow tract obstruction leads to fewer symptoms and better prognosis.•Treatment is primarily medical, not surgical.