Objectives. The aim of this study was to determine whether giant negative T (GNT) wave on electrocardiogram is specific for apical hypertrophic cardiomyopathy (ApHCM). Background. Apical hypertrophic cardiomyopathy is a subtype of hypertrophic cardiomyopathy, which is more frequently found in Asians than in Caucasians. It is clinically suspected by a characteristic GNT wave on electrocardiogram (ECG) and diagnosed by demonstrating apical hypertrophy on echocardiogram. Methods. By retrospectively collecting 12-lead ECGs with a GNT wave and apical hypertrophy on 2D-echocardiogram from 2008 to 2010, we identified 55 patients with both of these findings. Apically displaced papillary muscle (ADPM) was defined to be present when the base of papillary muscle originated from the apical one-third of the left ventricle. A diagnosis of ApHCM in patients with apical hypertrophy but without evidence of ADPM was given otherwise. Results. Careful evaluations of 2D-echocardiograms suggested that 20% (11/55) of all patients had an ADPM mimicking ApHCM. Baseline clinical and echocardiography data were not different between the two, suggesting that the differentiation of these two groups may be subtle and difficult. In addition, patients with ADPM frequently showed abnormal insertion of papillary muscle into the left ventricular outflow tract or into the base of mitral valve leaflet. Conclusions. Apically displaced papillary muscle may mimic ApHCM and further investigation is required to determine whether this entity is a subtype of ApHCM or a normal variant.