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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.

Ogunlade O, Ayoka AO, Akomolafe RO, Akinsomisoye OS, Irinoye AI, Ajao A, Asafa MA - J Med Case Rep (2015)

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Physiological Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria. oogunlade@oauife.edu.ng.

ABSTRACT

Introduction: Dextrocardia 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 presentation: We 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.

Conclusions: A 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.

No MeSH data available.


Related in: MedlinePlus

Chest X-ray (posterior anterior view) of a 22-year-old Nigerian man showing dextrocardia, with the cardiac apex pointing to the right. His aortic arch was located on the right. His stomach bubble was located below his right hemidiaphragm. His hepatic opacity was located below his left hemidiaphragm. His trachea was slightly deviated to the left
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Fig3: Chest X-ray (posterior anterior view) of a 22-year-old Nigerian man showing dextrocardia, with the cardiac apex pointing to the right. His aortic arch was located on the right. His stomach bubble was located below his right hemidiaphragm. His hepatic opacity was located below his left hemidiaphragm. His trachea was slightly deviated to the left

Mentions: We report a case of a 22-year-old Nigerian man of Yoruba ethnicity who presented himself for electrocardiographic screening as a pre-admission medical test. He had a standard 12-lead ECG which revealed uncommon features: inversion of P waves (atrial depolarization) in leads I, aVL and aVR; dominant S waves in leads I, V1 to V6 with reversed R wave progression in chest leads; low voltage QRS axis in V4 to V6; extreme QRS axis; flattened T waves (ventricular repolarization) in V4 to V6 and aVR; and inverted T waves in lead I and aVL (Fig. 1). An ECG diagnosis of dextrocardia was made; the differential diagnosis considered was right ventricular hypertrophy. The ECG electrodes were then placed in reverse order (mirror image position) on his body, which produced a normal standard 12-lead ECG pattern of a young adult. This confirmed dextrocardia with mirror image atrial arrangement (Fig. 2). On further evaluation, he revealed a 5-year history of recurrent abdominal pain and a 3-week history of catarrh, fever, cough, exercise intolerance and progressive weight loss. There was no history of chest pain, orthopnea, paroxysmal nocturnal dyspnea, palpitation or body swelling. He had no history of contact with someone with a chronic cough. There was a positive history of twins (twice) in his nuclear family. A physical examination revealed a slim young man not in obvious respiratory distress; he was not cyanosed, pale or febrile. He had neither finger clubbing nor pedal edema. A cardiovascular examination showed a 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 midclavicular line, and first and second heart sounds were heard. A chest X-ray (posterior anterior view) including upper abdomen showed dextrocardia, with the cardiac apex pointing to the right. His aortic arch was located on the right. His stomach bubble was located below his right hemidiaphragm. His hepatic opacity was located below his left hemidiaphragm. His trachea was slightly deviated to the left. The findings in the lung fields were not remarkable (Fig. 3). An abdominopelvic ultrasonography showed that his liver was located on the left side; it measured 14.5cm in span. The liver margin was smooth and the intrahepatic ducts and vascular channels were preserved. The gallbladder was seen in its inferior border. His spleen was located in the right hypochondrium; it was preserved sonographically. His stomach was on the right and his duodenum was located on the left. His two kidneys were seen in the renal beds bilaterally. His abdominal aorta was on the right while his inferior vena cava was located on the left. His urinary bladder was centrally placed and an assessment of situs inversus was made ultrasonographically. Overall, the diagnosis of dextrocardia with situs inversus to exclude Kartagener syndrome was made. Sputum microscopy, culture and sensitivity (MCS), sputum for acid-fast bacilli, chest CT scan and echocardiography were requested. He was placed on a combination of amoxycillin and azithromycin pending the result of his sputum tests. His sputum MCS showed Klebsiella species sensitive to cefuroxime. The sputum acid-fast bacilli test was negative. He was scheduled for echocardiography to determine cardiac structure and function; he was also scheduled for a chest CT. However, he had financial challenges which delayed completion of the investigations. Following completion of the initial antibiotics dosages, he was placed on cefuroxime and he became symptom free within 2 weeks of treatment.Fig. 1


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.

Ogunlade O, Ayoka AO, Akomolafe RO, Akinsomisoye OS, Irinoye AI, Ajao A, Asafa MA - J Med Case Rep (2015)

Chest X-ray (posterior anterior view) of a 22-year-old Nigerian man showing dextrocardia, with the cardiac apex pointing to the right. His aortic arch was located on the right. His stomach bubble was located below his right hemidiaphragm. His hepatic opacity was located below his left hemidiaphragm. His trachea was slightly deviated to the left
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4584464&req=5

Fig3: Chest X-ray (posterior anterior view) of a 22-year-old Nigerian man showing dextrocardia, with the cardiac apex pointing to the right. His aortic arch was located on the right. His stomach bubble was located below his right hemidiaphragm. His hepatic opacity was located below his left hemidiaphragm. His trachea was slightly deviated to the left
Mentions: We report a case of a 22-year-old Nigerian man of Yoruba ethnicity who presented himself for electrocardiographic screening as a pre-admission medical test. He had a standard 12-lead ECG which revealed uncommon features: inversion of P waves (atrial depolarization) in leads I, aVL and aVR; dominant S waves in leads I, V1 to V6 with reversed R wave progression in chest leads; low voltage QRS axis in V4 to V6; extreme QRS axis; flattened T waves (ventricular repolarization) in V4 to V6 and aVR; and inverted T waves in lead I and aVL (Fig. 1). An ECG diagnosis of dextrocardia was made; the differential diagnosis considered was right ventricular hypertrophy. The ECG electrodes were then placed in reverse order (mirror image position) on his body, which produced a normal standard 12-lead ECG pattern of a young adult. This confirmed dextrocardia with mirror image atrial arrangement (Fig. 2). On further evaluation, he revealed a 5-year history of recurrent abdominal pain and a 3-week history of catarrh, fever, cough, exercise intolerance and progressive weight loss. There was no history of chest pain, orthopnea, paroxysmal nocturnal dyspnea, palpitation or body swelling. He had no history of contact with someone with a chronic cough. There was a positive history of twins (twice) in his nuclear family. A physical examination revealed a slim young man not in obvious respiratory distress; he was not cyanosed, pale or febrile. He had neither finger clubbing nor pedal edema. A cardiovascular examination showed a 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 midclavicular line, and first and second heart sounds were heard. A chest X-ray (posterior anterior view) including upper abdomen showed dextrocardia, with the cardiac apex pointing to the right. His aortic arch was located on the right. His stomach bubble was located below his right hemidiaphragm. His hepatic opacity was located below his left hemidiaphragm. His trachea was slightly deviated to the left. The findings in the lung fields were not remarkable (Fig. 3). An abdominopelvic ultrasonography showed that his liver was located on the left side; it measured 14.5cm in span. The liver margin was smooth and the intrahepatic ducts and vascular channels were preserved. The gallbladder was seen in its inferior border. His spleen was located in the right hypochondrium; it was preserved sonographically. His stomach was on the right and his duodenum was located on the left. His two kidneys were seen in the renal beds bilaterally. His abdominal aorta was on the right while his inferior vena cava was located on the left. His urinary bladder was centrally placed and an assessment of situs inversus was made ultrasonographically. Overall, the diagnosis of dextrocardia with situs inversus to exclude Kartagener syndrome was made. Sputum microscopy, culture and sensitivity (MCS), sputum for acid-fast bacilli, chest CT scan and echocardiography were requested. He was placed on a combination of amoxycillin and azithromycin pending the result of his sputum tests. His sputum MCS showed Klebsiella species sensitive to cefuroxime. The sputum acid-fast bacilli test was negative. He was scheduled for echocardiography to determine cardiac structure and function; he was also scheduled for a chest CT. However, he had financial challenges which delayed completion of the investigations. Following completion of the initial antibiotics dosages, he was placed on cefuroxime and he became symptom free within 2 weeks of treatment.Fig. 1

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Physiological Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria. oogunlade@oauife.edu.ng.

ABSTRACT

Introduction: Dextrocardia 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 presentation: We 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.

Conclusions: A 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.

No MeSH data available.


Related in: MedlinePlus