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Year : 2018  |  Volume : 2  |  Issue : 2  |  Page : 137-138

Isolated hypertrophy of the left ventricular papillary muscles


Department of Cardiology, Mittal Hospital and Research Centre, Ajmer, Rajasthan, India

Date of Web Publication6-Sep-2018

Correspondence Address:
Dr. Sita Ram Mittal
11/101, Brahmpuri, Kutchery Road, Ajmer, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiae.jiae_58_17

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How to cite this article:
Mittal SR. Isolated hypertrophy of the left ventricular papillary muscles. J Indian Acad Echocardiogr Cardiovasc Imaging 2018;2:137-8

How to cite this URL:
Mittal SR. Isolated hypertrophy of the left ventricular papillary muscles. J Indian Acad Echocardiogr Cardiovasc Imaging [serial online] 2018 [cited 2018 Oct 23];2:137-8. Available from: http://www.jiaecho.org/text.asp?2018/2/2/137/240639

Isolated hypertrophy of the papillary muscles is a rare echocardiographic finding with isolated case reports.[1] Here, we report such a case.

A 20-year-old male presented with atypical chest pain. There was no history of breathlessness or syncope. His family history was not relevant. Clinical examination was normal. Electrocardiogram was unremarkable [Figure 1]. Skiagram of the chest was normal. Echocardiographic examination revealed isolated hypertrophy of both papillary muscles of the left ventricle [Figure 2]a and [Figure 2]b. Maximum end diastolic ventricular wall thickness was 10 mm at the interventricular septum in the parasternal short-axis view. Left ventricular systolic and diastolic functions were normal. There was no intraventricular or left ventricular outflow tract gradient. Color Doppler evaluation revealed mild eccentric mitral regurgitation [Figure 3]. Laboratory examination did not reveal any abnormality. The patient responded to analgesics. He refused for any further evaluation including genetic testing. First-degree relatives were asymptomatic and did not agree for screening.
Figure 1: Normal electrocardiogram

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Figure 2: (a) Apical four-chamber view showing hypertrophied papillary muscle. (b) Short-axis view showing hypertrophied papillary muscles. LV: Left ventricle, PM: Papillary muscle

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Figure 3: Color Doppler evaluation in apical four-chamber view showing hypertrophied papillary muscle and mild eccentric mitral regurgitation. RV: Right ventricle, RA: Right atrium, LA: Left atrium, LV: Left ventricle, PM: Papillary muscle, MR: Mitral regurgitation

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Isolated papillary muscle hypertrophy is a rare echocardiographic finding. Exact etiopathogenesis and clinical significance are not known. Some authors have postulated that it could be a variant of hypertrophic cardiomyopathy.[2],[3],[4] Increased left precordial voltage and/or nonspecific T-wave inversion has been reported in some cases.[5] Cardiac magnetic resonance is more sensitive in the precise evaluation of the papillary muscles.[5] More studies are needed to better understand this entity.

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Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Ker J. Solitary papillary muscle hypertrophy: A new echo-electrocardiographic syndrome? A case report. Angiology 2007;58:502-3.  Back to cited text no. 1
    
2.
Kobashi A, Suwa M, Ito T, Otake Y, Hirota Y, Kawamura K, et al. Solitary papillary muscle hypertrophy as a possible form of hypertrophic cardiomyopathy. Jpn Circ J 1998;62:811-6.  Back to cited text no. 2
    
3.
Correia AS, Pinho T, Madureira AJ, Araujo V, Maciel MJ. Isolated papillary muscle hypertrophy: A variant of hypertrophic cardiomyopathy? Do not miss a hypertrophic cardiomyopathy. Eur Heart J Cardiovasc Imaging 2013;14:296.  Back to cited text no. 3
    
4.
To AC, Lever HM, Desai MY. Hypertrophied papillary muscles as a masquerade of apical hypertrophic cardiomyopathy. J Am Coll Cardiol 2012;59:1197.  Back to cited text no. 4
    
5.
Ferreira C, Delgado C, Vázquez M, Trinidad C, Vilar M. Isolated papillary muscle hypertrophy: A gap in our knowledge of hypertrophic cardiomyopathy? Rev Port Cardiol 2014;33:379.e1-5.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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