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.

To summarize and analyze the clinical features of Apical hypertrophic cardiomyopathy (ApHCM) which was misdiagnosed before the gross deformity of the papillary muscles and moved down to the apex of the heart due to the presence of Giant Negative T-wave (GNT). The clinical data of 215 patients who were previously diagnosed with ApHCM due to the presence of GNT in our hospital from 2006 to 2018 were retrospectively analyzed. Results: After careful observation and combined with LVO examination, 11 cases were found to have clinical features of large papillary muscle deformity and the position was moved down to the apex (ADPM). 9 cases of them were: anterior wall myocardial ischemia, patients with 6–14mm T wave inversion in leads V4-V6; 2 cases of inferior wall ischemia, middle-aged male patients with recurrent chest tightness, shortness of breath1 More than hours, especially after fatigue. ECG tips: sinus rhythm, normal ECG axis, 6-10mm T wave inversion, no abnormal angiography, echocardiography shows left ventricular wall structure, exercise, and left ventricular ejection fraction (LVEF) Within normal range. Echocardiography showed that the papillary muscles were thick and moved down, and the GNT corresponded to leads II, III, and AVF. This report shows that the huge negative T wave is not a specific manifestation of myocardial ischemia. The diagnosis is ApHCM is a misdiagnosis. Abnormal papillary muscle location and papillary muscle morphology can also lead to the occurrence of GNT.