Dextrocardia

Published on 02/04/2015 by admin

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Last modified 22/04/2025

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26 Dextrocardia

Instruction

Examine this patient’s precordium.

Listen to this patient’s heart.

Salient features

History

• Asymptomatic

• Obtain history of cough with purulent expectoration (bronchiectasis) and sinusitis.

Examination

• Apex beat is absent on the left side and present on the right.

• Heart sounds are better heard on the right side of the chest.

• Ascertain whether the liver dullness is present on the right or left side.

• Examine the chest for bronchiectasis.

• Proceed by telling the examiner that you would like to perform the following checks:

• Chest radiograph (looking for right-sided gastric bubble; (Fig. 26.1)

• ECG (inversion of all complexes in lead I; Fig. 26.2).

Fig. 26.1 Situs inversus. The heart, stomach, and liver are all in reversed positions (check that the right and left markers are placed correctly).

(With permission from Mettler 2004.)

Fig. 26.2 Dextrocardia. Negative QRS wave on lead I and negative P, QRS and T waves on leads I and aVL. Isoelectric aVR. Negative QRS and T waves in all the precordial leads.

Notes

• Dextrocardia without evidence of situs inversus is usually associated with cardiac malformation. It may occur with cardiac malformation in Turner syndrome.

• Situs solitus means normal position.

Diagnosis

This patient has dextrocardia (lesion) of congenital aetiology.

Advanced-level questions

What is Kartagener syndrome?

A type of immotile cilia syndrome in which there is dextrocardia or situs inversus, bronchiectasis and dysplasia of the frontal sinuses (Beitr Klin Tuberk 1933;83:489; N Engl J Med 1953;248:730).

Which other abnormality has been associated with dextrocardia?

Asplenia (blood smear may show Heinz bodies, Howell–Jolly bodies) (Br Heart J 1975;37:840).

What do you understand by the term situs inversus?

Right-sided cardiac apex, right stomach, right-sided descending aorta. The right atrium is on the left. The left lung has three lobes and the right lung has two.

What do you understand by the term dextroversion?

Right-sided cardiac apex, left-sided stomach and left-sided descending aorta.

What do you understand by the term levoversion?

Left-sided apex, right-sided stomach and right descending aorta.

M Kartagener (b. 1897), a Swiss physician, described this condition in 1933.

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