E-page Original Images: A frequently overlooked etiology of negative precordial T wave: solitary papillary muscle hypertrophy

Negative T wave on precordial leads is one of the most frequently encountered electrocardiographic (ECG) abnormality. Their significance depends on the electrocardiographic location, temporal evolution, and reversibility. A 43-year-old male patient without any symptom presented with inverted T waves on ECG during a routine check-up. The ECGs showed persistent inverted T waves in lateral derivations (Fig. 1). On echocardiographic examination, left ventricular and right ventricular systolic and diastolic functions were within normal limits. Both ventricles were normal in thickness and had no wall motion abnormality. However, the posterior papillary muscle was thick in apical four-chamber view (Fig. 2). Its echogenicity has also been increased, compared to the septum and the adjacent lateral wall. The routine biochemistry, whole blood test, coronary angiography and myocardial perfusion scintigraphy were normal.