The Features of Electrocardiography on Dextrocardia with Situs Inversus in Adult Patient

Author : I.N. Shabrina, M.G. Soewandi
Upload Date : 19-04-2018

Background: Dextrocardia with situs inversus is a rare congenital condition. The heart 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 probably later in adulthood.

Case Report: A 39 years old woman presented to the orthopaedic department with the chief complaint of shoulder pain on the left side after having traffic accident two days earlier. She was underwent examination and diagnosed with close comminuted fracture of the left humeral head by the orthopaedician. The physical examination showed pulse rate of 86 beats per minute, blood pressure of 120/80 mmHg, and the ictus cordis was located at the fifth right intercostal space mid-clavicular line. Electrocardiography and X-ray was taken for preoperative routine test. Firstly, 12-lead electrocardiography was performed, which later revealed uncommon features: inversion of P waves in leads I, aVL, and aVR; dominantly negative QRS waves in leads I, aVR, and V1 to V6; reverse R wave progression in chest leads; low voltage in V4 to V6; flattened T waves in V4 to V6 and aVR; and inverted T waves in lead I and aVL. The electrocardiogram diagnosis of dextrocardia was made with right ventricular hypertrophy as the differential diagnosis. A chest X-ray on posterior-anterior view including upper abdomen showed dextrocardia and situs inversus. The aortic arch was located on the right. The stomach bubble was located below the right hemidiaphragm. The liver opacity was sighted below the left hemidiaphragm. The trachea was slightly deviated to the left. And there isn’t any remarkable finding in her lung fields.

Conclusion:  The electrocardiogram is a valuable tool and diagnostic aid in the evaluation of many cardiac test. A properly interpreted electrocardiogram was useful in suspecting the diagnosis of dextrocardia. So, an analysis of a relatively simple and non-invasive diagnostic tool such as an electrocardiogram allows for suspicion of a cardiovascular anomaly. The interpretation might confirmed with other tools such as x-ray and abdominopevic ultrasonography.

KEYWORDS : Dextrocardia, Electrocardiogram, Young adult

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