Acute myocardial infarction in a patient of dextrocardia and situs inversus totatis—when right is not right

Abstract

Diagnosis of myocardial infarction in patients with dextrocardia and situs inversus is considerably difficult. The clinical diagnosis and electrocardiography (ECG) recognition in this setting poses significant challenges, as the clinical signs may be misleading and the ECG changes may simply be interpreted to be due to improper lead placement. In this case report we report one such case of acute myocardial infarction in a patient of situs inversus totalis. A deviated apex beat and heart sounds coupled with right axis deviation of P wave and QRS complexes in lead I, and positive R wave in aVR lead to the diagnosis of dextrocardia. Elevated ST segment in Vl and right-sided leads indicated acute myocardial infarction which was later confirmed by raised creatine phosphokinase-MB (CPK-MB) levels, and transthoracic echocardiography.