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Jason's Blog: ECG Challenge for the month of June, 2014.

jer5150's picture

This is an ECG I performed on a 65-year old man about 5 years ago.  He mentioned something to me about his past medical history before we got started but, in truth, I would have recognized it had he not told me beforehand.  What did he tell me and what does this ECG reveal? 

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global negativity in lead I, tall R wave in aVR, and reverse r progression are well correlated with dextrocardia..I would like to perform CXR to look for it.. dextrocardia can be presented solely or with situs invertus in kartagener syndrome (bronchiectasis and primary ciliary dyskinesia) and and also I would like to find the apex of the heart and auscultate..leads misplacement must b entertained too.

Dave Richley's picture

There is dextrocardia here, but that’s not all. The frontal plane T wave axis is very different from the QRS axis and the shape of the T wave, together with the QRS voltage, in the limb leads is suggestive of LVH. Obviously, the QRS voltages in the chest leads are unhelpful in this case, but the T wave inversion in V1, which corresponds to V2 if the heart were normally positioned, is abnormal and suggests that something is wrong.

Dave R

jer5150's picture
Submitted by jer5150 on

INTERPRETATION:
(1.)  Sinus rhythm (rate 62/min) with . . .
(2.)  . . . mirror-image dextrocardia.
(3.)  Probable left ventricular hypertrophy (LVH).

COMMENTS:
This is recognized as dextrocardia by the inverted P-wave and QRS complex in lead I.  This finding is associated with a decreasing R-wave amplitude from leads V1 to V6.  The obvious differential diagnosis would be switching of the right and left arm cables.
Invariably, the computer will erroneously interpret the ECG with the following statements: 
"*** Suspect arm lead reversal, interpretation assumes no reversal"
"anterolateral myocardial infarction (Age indeterminate)".

Compare this case to one that I posted 2 years ago:  http://ecgguru.com/ecg/reversed-arm-cables

Jason E. Roediger - Certified Cardiographic Technician (CCT)
ECG....@gmail.com

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