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    Left Ventricular False Tendon
    Recently I came across one ECG related article which described a condition known as left ventricular false tendon. That prompted me to go a little deeper. I don’t know how many of you know this before, but to me it is new topic. I though I will share a few points with my friends through this column.
    Left ventricular false tendon (FT) was first described in 1893 by Dr Turner, who observed it on dissection of the human heart.1 This fibromuscular structure originates in the interventricular septum and crosses the left ventricle to the papillary muscles, lateral wall, or cardiac apex.
    The percentage of FT visualization in humans has been rising with technical improvements: the earliest studies report rates of 0.5% whereas current investigations have achieved up to 78%.False tendon has been related to clinical signs, such as innocent murmur, conduction and heart rate abnormalities, cavitary thrombi, and even infections, although there is no consensus on the implication of FT in human physiology or disease. Its morphogenesis and embryonic origin are not well known, and prenatal imaging has been rare, with only a few reports of the condition observed during the fetal period.
    The implication of FT for cardiac physiology is still unknown, and its association with some heart diseases has not been well determined; hence, there is no consensus that the finding has clinical implications.
    The pediatric population study found FT on ultrasound in 83% of patients, which is the highest frequency of FT found by ultrasound in published studies to date. Unlike the dissection studies, not all FTs were found for 2 reasons: 1) FTs are sometimes thin and can go unnoticed and 2) visualization of FTs in the apex may be impossible because the region is hard to examine by echocardiography and most FTs are found during dissection
    The most widely accepted association is with innocent murmur in children. Fetal echocardiography has demonstrated the presence of FTs as of week 20. General consensus is that it must originate from the time of organogenesis.

    LV tendon.jpg

    From the Journal of American College of Cardiology I reproduce the following to impress that this condition is not confined to paediatric population alone
    The prevalence of left ventricular false tendons, premature ventricular complexes and their coexistence was evaluated prospectively in 187 healthy company workers aged 21 to 50 (mean 36) years. False tendons were demonstrated echocardiographically in 133 (71%). Eight subjects were withdrawn from the study because of silent mitral valve prolapse. In these 179 healthy subjects, false tendons were detected in 127 (71%) and premature ventricular complexes in 48 (27%).
    http://content.onlinejacc.org/article.a … id=1113420

    Most importantly I want to show the ECG changes that shows ST segment elevation in V1, V2 and V3 suggestive of acute myocardial infarction. Clinicians should keep this in mind before taking a decision when one encounters such ECGs.

    LV Tendon ECGsmall.jpg

    UA Mohammed

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