A 30-year-old male presented with cough, cold, and myalgia symptoms for several days. An ECG was performed which showed the following abnormalities: positive P waves, right axis deviation, and reversal of the normal QRS pattern with the tallest amplitude in V1 diminishing to V6. Chest X-ray and echocardiogram revealed dextrocardia with situs inversus totalis, a rare condition where the internal organs are mirrored. The ECG findings are consistent with this anatomical anomaly.

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

2. Clinical History:Clinical History:
30 yrs old male30 yrs old male
h/o cough, cold x 3 daysh/o cough, cold x 3 days
Severe myalgia x 1 daySevere myalgia x 1 day
O/EO/E
AfebrileAfebrile
Vitals stableVitals stable

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

5. Contd.,Contd.,
Configuration-Configuration-
1. Reversal of QRS pattern.1. Reversal of QRS pattern.
Tallest in V1 and progressivelyTallest in V1 and progressively
dimnishing to lead V6.dimnishing to lead V6.
2.slurring of downstroke of2.slurring of downstroke of
QRS in L2QRS in L2
3.’M’ pattern in L2,L33.’M’ pattern in L2,L3

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

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

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

9. FEW DEFINITIONSFEW DEFINITIONS::
DEXTROCARDIA-DEXTROCARDIA-
1.Isolated dextrocardia is transposition of the heart1.Isolated dextrocardia is transposition of the heart
without accompanying alteration of the abdominalwithout accompanying alteration of the abdominal
viscera.viscera.
2.Mirror-image dextrocardia-location of the heart in the2.Mirror-image dextrocardia-location of the heart in the
right side of chest, the atria being transposed and rightright side of chest, the atria being transposed and right
ventricle lying anteriorly and left of the left ventricle.ventricle lying anteriorly and left of the left ventricle.
DEXTROPOSITION OF THE HEART- A congenitalDEXTROPOSITION OF THE HEART- A congenital
anomaly in which an anatomically correct heart isanomaly in which an anatomically correct heart is
displaced to the right in thoracic cavity.displaced to the right in thoracic cavity.

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

11. THANK YOUTHANK YOU