Myocardial calcification limited to the papillary muscles is a rare disorder.'-3 Recently, we encountered a patient with mitral valve prolapse associated with severe mitral regurgitation, ventricular tachycardia, and a densely calcified papillary muscle initially diagnosed by echocardiography. The diagnosis was subsequently supported by cardiac catheterization data and confirmed at operation and histological study.
CASE HISTORY
A 61-yr-old woman presented for evaluation of dyspnea and ventricular arrhythmia. She had known of a heart murmur since childhood. One year prior to admission, she noted palpitations and suffered several syncopal episodes. Ambulatory electrocardiographic monitoring disclosed paroxysmal ventricular tachycardia associated with dizziness and loss of consciousness. The arrhythmia was poorly controlled by various antiarrhythmic agents. The patient complained of increasing dyspnea and orthopnea. Chest pain atypical of angina pectoris was a prominent symptom. She was admitted for further evaluation.
The patient denied having a history of renal or bone disease or any disorder of calcium metabolism.
Physical examination revealed a welldeveloped woman with a regular pulse of 78 beats per minute and a blood pressure of 112/80 mmHg.
No skeletal abnormalities were noted. The lungs were clear. An apical left ventricular heave and systolic thrill were palpated. A loud, late systolic