BACKGROUND Wellens syndrome is a form of unstable angina that warrants a timely intervention to prevent extensive myocardial infarction. A few conditions can lead to electrocardiogram (EKG) changes mimicking Wellens syndrome. CASE REPORT A 61-year-old African American man with no significant medical history was admitted for chest pain and new biphasic EKG changes in leads V2 through V6 concerning for Wellens' syndrome. He was found to have hypertension during his hospitalization and had left ventricular hypertrophy by echocardiogram. He was urgently evaluated with a cardiac catheterization, which demonstrated a normal coronary artery anatomy. The patient was diagnosed with pseudo-Wellens syndrome. CONCLUSIONS LVH secondary to hypertension could mimic Wellens syndrome and should be considered when evaluating patients with anterior T wave abnormalities on electrocardiograms. In patients who do not have acute coronary syndrome and in whom the T wave abnormalities are not classic for Wellens-type changes, non-invasive imaging instead of cardiac catheterization may be indicated initially.