1. The ECG shows signs of dextrocardia including a positive P wave, right axis deviation, and reversal of the normal QRS pattern. 2. Chest X-ray and echocardiogram confirmed dextrocardia with situs inversus totalis, a rare condition where the heart is located on the right side of the chest and major visceral organs are mirrored. 3. Dextrocardia with situs inversus totalis usually indicates a normally structured heart, while dextrocardia without situs inversus or with uncertain organ positioning often involves complex cardiac anomalies.

1. .
WEEK
ECG OF THE
Dr.B.Gowrishankar.
Prof.G.Sundaramurthy’s unit.

2. Clinical History:
30 yrs old male
h/o cough, cold x 3 days
Severe myalgia x 1 day
O/E
Afebrile
Vitals stable

4. ECG SHOWS
Rate-60 /min
Rhythm-Normal sinus rhythm
P wave-Inverted in L1, aVL.
Slightly upright in aVR
PR interval-0.16 s
QRS Complex:
width-0.08 s
axis-RAD-100*

5. Contd.,
Configuration1. Reversal of QRS pattern.
Tallest in V1 and progressively
dimnishing to lead V6.
2.slurring of downstroke of
QRS in L2
3.’M’ pattern in L2,L3

6. Contd.,
ST segment- Isoelectric in all leads except
L2 and L3.
T wave- Inverted in L1,aVL,V2-V6.
isoelectric in aVR.
COMMENTS:
1.Positive P waves.
2.Right axis deviation.
3.Reversal of QRS pattern.

7. CONCLUSION:
CXR – Dextrocardia.
ECHO- Situs inversus totalis.

8. DIFFERENTIAL DIAGNOSIS:
Reversal of limb leads:
(Incorrectly placed arm electrodes)
The precordial leads will show
normal QRS pattern.

9. FEW DEFINITIONS:
DEXTROCARDIA1.Isolated dextrocardia is transposition of the heart
without accompanying alteration of the abdominal
viscera.
2.Mirror-image dextrocardia-location of the heart in the
right side of chest, the atria being transposed and right
ventricle lying anteriorly and left of the left ventricle.
DEXTROPOSITION OF THE HEART- A congenital
anomaly in which an anatomically correct heart is
displaced to the right in thoracic cavity.

10. SIGNIFICANCE:
1. When dextrocardia occurs with situs inversus
the heart is most frequently normal.
2. When dextrocardia occurs without situs
inversus, when the visceral situs is
indeterminate (situs ambigus) or if isolated
levocardia is present complex multiple
anomalies are usually present.
3. Dextrocardia with situs solitus or situs
ambigus is less common and the incidence of
CHD is extremely high, probably 90%or greater.

11. THANK YOU