A patient with dextrocardia at the outpatient stage: The complexity of diagnosis

Abstract

Understanding the specific features of this condition – dextrocardia (a congenital heart anomaly) – is important for physicians of various specialties, as it may affect patient management tactics and the choice of treatment methods. The presented clinical observation presents the features of observation and diagnosis of a patient with a developmental anomaly. The patient of 22 years old came to the local outpatient clinic for dynamic observation. Anamnesis: the patient has no hereditary predisposition to cardiovascular diseases. The following examination methods were performed: electrocardiography (ECG), echocardiography (EchoCG) and laboratory tests. The results showed that the patient has signs of acute coronary syndrome. This conclusion was made incorrectly, since the patient’s specific feature was not taken into account when applying the electrodes. When taking an ECG from a patient with dextroversion, the electrodes are applied as if the heart is left-sided, which leads to questionable and unreliable research results. Thus, judging by the latest examination results, the ECG suggests the presence of a possible previous inferior MI of indefinite duration, while the ECHO-CG confirms the absence of zones of impaired local contractility and the presence of satisfactory general contractility. It can be concluded that with a right-formed, right-located heart, it is inappropriate to apply electrodes during ECG recording, as with a left-sided position of the heart. With dextroversion, the electrocardiogram (ECG) may be uninformative due to the atypical location of the heart. In this case, additional examination methods are used for accurate diagnosis and assessment of the patient’s condition – ultrasound – EchoCG, computed tomography.