Key result
Cardiac MRI differentiates papillary muscle abnormalities mimicking apical hypertrophic cardiomyopathy on ECG.
Why the study?
ECG findings characteristic of ApHCM are not specific and can be mimicked by papillary muscle abnormalities, making differentiation important due to substantial differences in disease course, treatment, and prognosis.
Case Report (n=2)
Cardiac MRI is crucial for differentiating benign papillary muscle abnormalities from apical hypertrophic cardiomyopathy in patients presenting with giant T wave inversions.
May prompt MRI when ECG suggests apical HCM but echo is negative; case report extends differential diagnosis but leaves open systematic validation.
Background: Apical hypertrophic cardiomyopathy (ApHCM) is often associated with characteristic giant T wave inversions (GNT) in precordial leads without septal Q waves and increased QRS voltage on 12-lead electrocardiograms (ECGs). However, these electrocardiographic findings are not specific to ApHCM and can be mimicked by papillary muscle abnormalities. Differentiation between the two is important as the disease course, treatment, and prognosis differ substantially. Case summary: We report a case report of two such patients both of which presented with abnormal ECGs concerning for ApHCM. Echocardiogram did not show characteristic findings of ApHCM. Cardiac magnetic resonance imaging (MRI) showed apically displaced, hypertrophied papillary muscles responsible for electrocardiographic abnormalities. Discussion: Papillary muscle abnormalities including hypertrophy and/or apical displacement can result in giant negative T wave and increased QRS voltage like those seen in ApHCM and should be considered especially in otherwise healthy individuals with normal or near-normal transthoracic echocardiograms. Role of cardiac MRI is critical in this context and is the imaging modality of choice for accurate diagnosis.
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Janjua et al. (2023) conducted a case report in Papillary muscle abnormalities mimicking apical hypertrophic cardiomyopathy (n=2). Papillary muscle abnormalities was evaluated. Papillary muscle abnormalities such as apical displacement and hypertrophy can mimic electrocardiographic findings of apical hypertrophic cardiomyopathy, requiring cardiac MRI for accurate diagnosis.
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