To the Editor:
A 19-year-old female college student presented to the emergency room with sudden onset of palpitations while watching a movie. Her history was unremarkable, and she denied any abuse of alcohol, recreational drugs, or over-the-counter stimulants. Review of systems was negative for any recent fever, rash, sick contacts, or acute illness involving the respiratory or gastrointestinal tract. Vital signs on presentation were notable for a temperature of 100.1°F, a regular tachycardia at 220 beats per minute, and blood pressure 120/70 mm Hg. The remainder of the examination and a chest radiograph were unremarkable. The electrocardiogram showed a wide complex tachycardia with monophasic right bundle branch morphology in lead V1 and right inferior QRS axis (Figure 1). Intravenous procainamide was administered, with prompt restoration of sinus rhythm. The sinus rhythm electrocardiogram was normal. Transthoracic echocardiography revealed normal left ventricular function, homogeneous enlargement of the anterolateral papillary muscle, and mild mitral regurgitation (Figure 2). Differential diagnosis included a cardiac tumor, unusual isolated papillary muscle hypertrophy, or an infiltrative systemic process, …
Address correspondence to Dr. A. Rahimi, Division of Cardiology, Beth Israel Deaconess Medical Center, 185 Pilgrim Road, West Baker 4, Boston, MA 02215. E-mail: arahimi{at}bidmc.harvard.edu