The role of electrocardiogram in the diagnosis of dextrocardia with mirror image atrial arrangement and ventricular position in a young adult Nigerian in Ile-Ife: a case report

Abstract

IntroductionDextrocardia with situs inversus is a rare congenital disease. In patients with this condition, the heart is presented as a mirror image of itself with its apex pointing to the right. The pulmonary and abdominal anatomies are reversed. Dextrocardia with situs inversus occurs at birth but its diagnosis may be in adulthood. This case advances knowledge by graphically describing the unusual electrocardiographic features of dextrocardia in a young adult.Case presentationWe report a case of a 22-year-old Nigerian man of Yoruba ethnicity who presented himself for preadmission medical test. He had a standard 12-lead electrocardiogram which revealed uncommon features: inversion of P waves in leads I, aVL and aVR; dominantly negative QRS waves in leads I, V1 to V6; reverse R wave progression in chest leads; low voltage in V4 to V6; extreme QRS axis; flattened T waves in V4 to V6 and aVR; and inverted T waves in lead I and aVL. An electrocardiogram diagnosis of dextrocardia was made. The differential diagnosis considered was right ventricular hypertrophy. A cardiovascular examination showed pulse rate of 70 beats per minute, blood pressure of 119/62mmHg, visible cardiac impulse at right precordium, apex beat was located at his fifth right intercostal space mid-clavicular line. A chest X-ray (posterior anterior view) including upper abdomen showed dextrocardia; his aortic arch was located on the right. His stomach bubble was located below his right hemidiaphragm. His trachea was slightly deviated to the left. The findings in his lung fields were not remarkable. Abdominopelvic ultrasonography showed that right-sided intra-abdominal organs (liver, gallbladder) were located on the left while left-sided organs (stomach, spleen) were located on the right. His abdominal aorta was on the right while his inferior vena cava was located on the left. A diagnosis of dextrocardia with situs inversus was made ultrasonographically.ConclusionsA properly interpreted electrocardiogram was useful in suspecting the diagnosis of dextrocardia with situs inversus. So, an analysis of a relatively simple and non-invasive diagnostic tool such as an electrocardiogram allows for suspicion of a cardiovascular anomaly in a setting of scarce diagnostic resources.

Dextrocardia con situs inversus. Análisis cardiológico comprensible

“…Estos hallazgos podrían corresponder a hipertrofia ventricular derecha, lo cual se descarta por la ausencia de complejos de alto voltaje con signos de sobrecarga sistólica de ventrículo derecho en derivadas V1-V3. En el contexto electrocardiográfico de dextrocardia, la onda p rítmica negativa en I y aVL positiva en aVR corresponderían a un ritmo sinusal con origen atrial izquierdo, en otras palabras, la aurícula morfológica derecha situada a la izquierda, definiéndose así el situs inversus (10) .…”

Dextrocardia with complete AV block and the implantation of a temporary pacemaker before cesarean section

“…Furthermore, a properly interpreted electrocardiogram can be useful in suspecting the diagnosis of dextrocardia with SIT. [5] Our patient was diagnosed using X-ray and ultrasonography when she was 5 years old. She had corrective surgery when she was 6 years old.…”

Mirror Image Dextrocardia in a Left Handed Female Presenting With Left Sided Appendicitis

“…CT and CMR may be used to gather greater anatomic information of visceral organ position, cardiac apical position, intracardiac anatomy and great vessel branching. [7] Electrocardiographic features include: inversion of all complexes, aka 'global negativity' (inverted P wave, negative QRS, inverted T wave) in lead 1, Positive QRS complexes (with upright P and T waves) in aVR, dominant S waves in leads I and V1 to V6, reversed R wave progression in chest leads, low voltage QRS axis in V4 to V6,Right axis deviation, flattened T waves in V4 to V6 and aVR and inverted T waves in lead I and aVL. [8] Early diagnosis of situs inversus total is is important because the thoracic and abdominal surgical approach is different and certain diseases could be presented with unusual characteristics.…”