An ST-Elevation Myocardial Infarction In Situs Inversus Totalis (DEXTROCARDIA).

Abstract

A 63-year-old woman with medical history significant for peripheral artery disease, hypertension, hyperlipidema and a 20 pack-year smoking history presented to the emergency department after waking from sleep at 3 am with severe indigestion, nausea, and emesis. On arrival the patient was mildly hypotensive to 102/61 mm Hg with a heart rate of 70 beats/min, and saturating 94% on room air. She had had a dobutamine stress echocardiogram 1 month prior, which was “unremarkable.” The patient added, during electrocardiogram (ECG) lead placement, that her “heart is on the right side” and the ECG was obtained with right-sided precordial leads and standard limb leads (Figure 1). The ECG was repeated with purposeful limb lead reversal in addition to right-sided reversed precordial leads (Figure 2). The patient's chest xray can be seen in Figure 3. Figure 2Electrocardiogram with complete appropriate reversal including limb leads and right anterior precordial leads. Note appropriate QRS in aVL and aVR. Resolved global negativity in lead I. View Large Image Figure Viewer Download Hi-res image Figure 3Chest x-ray study showing dextrocardia. View Large Image Figure Viewer Download Hi-res image