Dextrocardia By Dr. Vaibhav Yawalkar

Dextrocardia classification , presentation, significance and ECG features - By Dr. Vaibhav Yawalkar , MD

1. Dextrocardia Dr. Vaibhav Yawalkar, MD

2. Presentation: Depends on type and associated cardiac anomalies. Dextrocardia with other heart defects is more common than dextrocardia with normal heart. Most severe form is “ Heterotaxy ”, in which multiple other organs are not at their normal anatomical locations and/or malformed.

3. Presentation: These cases usually present in early childhood with heart failure , or other organs related symptoms, mostly recurrent fulminant infections due to asplenia. Patients with Dextrocardia & no other cardiac anomalies are asymptomatic and often detected on clinical or radiological examination done for unrelated illness.

4. Terminology: Dextroversion or Dextrorotation : Rotation of heart around vertical axis, such that left ventricle lies anterior to Right ventricle. Dextroposition: Anatomically normal heart is shifted to right due to some acquired pathology, such as Right Lung fibrosis , collapse or Left sided massive pleural effusion or pneumothorax etc. Dextrocardia: Mirror image anatomical position along vertical axis.

5. Types: Dextrocardia of Embryonic arrest : Also called as Isolated Dextrocardia, almost always associated with severe cardiac defects. Dextrocardia with Situs Inversus: Generally without any cardiac defects. Autosomal Recessive condition. If Situs inversus is with Levocardia ,it is almost always associated with severe cardias defects. Overall Incidence of Dextrocardia: 1 in 12000 people

6. Etiology: Genetic Predisposition (Autosomal Recessive Situs Inversus) Problems during organogenesis and rotation of viscera. Association with Kartagener syndrome (50% patients has situs Inversus Dextrocardia)

7. ECG Features:

8. aVR = Normal aVL aVL = Normal aVR aVF = aVF Lead I = Reverse of Normal Lead I Lead III = Lead II Lead II = Lead III

9. ECG Features: Right Axis deviation aVR : Upright P & T wave Positive QRS Lead I : Inverted P, T, and QRS Chest Leads: Absent “r” progression Dominant “s” wave throughout.

10. Significance: Recognising correct anatomy during surgical procedure. Subconsciously labelling on Chest X-ray may be ignored by physicians and they may hold it incorrectly to offset for dextrocardia, which leads to wrong localization of lung pathology if clinical findings are subtle. Maintaining Base to Apex position of electrodes during Electrical cardioversion. (?) While recording ECG in known dextrocardia patient, Reverse Limb leads as well as chest leads, especially for localising current of injury.

11. NORMAL IN DEXTROCARDIA RA LA RF LF

12. V 2 V 1