ECG: Dextrocardia

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ECG: Dextrocardia

  1. 1. .. ECG OF THEECG OF THE WEEKWEEK Dr.B.Gowrishankar.Dr.B.Gowrishankar. Prof.G.Sundaramurthy’s unit.Prof.G.Sundaramurthy’s unit.
  2. 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
  3. 3. 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*
  4. 4. 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
  5. 5. 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.
  6. 6. CONCLUSION:CONCLUSION: CXR – Dextrocardia.CXR – Dextrocardia. ECHO- Situs inversus totalis.ECHO- Situs inversus totalis.
  7. 7. 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.
  8. 8. 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.
  9. 9. 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.
  10. 10. THANK YOUTHANK YOU

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