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Mirror-image dextrocardia

jer5150's picture

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

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? 

Dextrocardia

Wed, 05/22/2013 - 20:11 -- Dawn

 This middle-aged man presents to the Emergency Dept. complaining of shortness of breath and fever.  Blood work, chest xray, and ECG are ordered.  When the ER Tech obtains the 12-Lead ECG, he is puzzled by the following findings: 

Low voltage in the chest leads V2 - V6

Abnormal right axis of P waves with negative P waves in Leads I and aVL

Abnormal right QRS axis with an upright aVR. 

Seeing his puzzled look, the patient says, "Oh, I forgot to tell you, I have mirror-image dextrocardia!"

After consulting with the ED physician, the Tech reverses the arm leads and the chest leads and obtains the second ECG.

 

 The P wave axis is now correct, although there is still derangement of the QRS axis.  The QRS complexes in the chest leads look more normal, but do not show the usual R wave progression of the normal ECG.

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