Eleven patients with deformed papillary muscles and downward movement
were misdiagnosed as cardiomyocyte ischemia due to giant negative T wave
Abstract
Objective: To analyze the clinical manifestations of a huge inverted T
wave and to summarize the causes of misdiagnosis of deformed papillary
muscle as myocardial ischemia. Cases and Results: A retrospective
analysis of the clinical data of 215 patients with 12-lead ECG T wave
inverted myocardial ischemia from 2006 to 2018 in our hospital. Combined
with multi-factor logistic regression analysis of echocardiography and
electrocardiogram, we evaluated 11 cases of unique clinical malformed
papillary muscles with lowered position. The electrocardiogram showed
sinus rhythm, the electrocardiogram axis was normal, and the T wave
inversion was 6-10 mm. The angiography showed no abnormalities. The
echocardiogram showed that the left ventricular wall structure, motion,
and left ventricular ejection fraction were within the normal range.
Echocardiography showed that the anterolateral papillary muscle base of
11 patients originated from the apex 1/3. A 12-lead ECG with deformed
papillary muscles shows that a huge inverted T wave is not a feature of
myocardial ischemia. In this case, the 12-lead ECG feature is
insufficient to identify the cause of myocardial ischemia. Therefore, we
must exclude these myocardial ischemia in order to diagnose and treat
correctly. Conclusion: Conventional 12-lead electrocardiogram shows that
the giant inverted T wave of the deformed papillary muscles is diagnosed
as myocardial ischemia, which is a misdiagnosis.